Continuous monitoring of global left ventricular ejection fraction during percutaneous transluminal coronary angioplasty

Continuous monitoring of left ventricular (LV) function during percutaneous transluminal coronary angioplasty (PTCA) was performed in 40 patients (53 +/- 2 years) with a miniature, nuclear detector system after labeling the patients' red blood cells with technetium-99m. Balloon dilation (113 seconds, range 60 to 240) induced on average a 0.12 ejection fraction (EF) unit (19%) decrease in the LVEF, which was explained by a 34% increase in end-systolic counts. Balloon dilation of the left anterior descending artery (n = 23) produced a decrease in the LVEF of 0.17 +/- 0.13 EF units compared with the decrease of 0.06 +/- 0.07 EF units in patients undergoing dilation of the left circumflex artery (n = 9) and 0.05 +/- 0.04 EF units in patients treated for a stenosis of the right coronary artery (n = 8), (p = 0.02). Balloon deflation was associated with an immediate return to pre-PTCA levels. In 10 patients with 2 identical balloon occlusions, the second occlusion led to a significantly less decrease in the LVEF (0.41 +/- 0.14 vs 0.44 +/- 0.15) and electrocardiographic ST-segment deviation (88 +/- 54 microV vs 65 +/- 42 microV) than the first. We conclude that PTCA is associated with an abrupt transient decrease in the LVEF. The effect of balloon occlusion of the left anterior descending artery is more pronounced than balloon occlusion of the left circumflex and the right coronary arteries. Neither single nor multiple balloon occlusions were associated with post-PTCA global LV dysfunction, whereas the lesser degree of LV dysfunction and electrocardiographic signs of myocardial ischemia during the second of 2 identical balloon occlusions suggests that preconditioning can be induced during PTCA.     

Muscle function during brief maximal exercise: accurate measurements on a friction-loaded cycle ergometer

A friction loaded cycle ergometer was instrumented with a strain gauge and an incremental encoder to obtain accurate measurement of human mechanical work output during the acceleration phase of a cycling sprint. This device was used to characterise muscle function in a group of 15 well-trained male subjects, asked to perform six short maximal sprints on the cycle against a constant friction load. Friction loads were successively set at 0.25, 0.35, 0.45, 0.55, 0.65 and 0.75 N.kg-1 body mass. Since the sprints were performed from a standing start, and since the acceleration was not restricted, the greatest attention was paid to the measurement of the acceleration balancing load due to flywheel inertia. Instantaneous pedalling velocity (v) and power output (P) were calculated each 5 ms and then averaged over each downstroke period so that each pedal downstroke provided a combination of v, force and P. Since an 8-s acceleration phase was composed of about 21 to 34 pedal downstrokes, this many v-P combinations were obtained amounting to 137-180 v-P combinations for all six friction loads in one individual, over the widest functional range of pedalling velocities (17-214 rpm). Thus, the individual's muscle function was characterised by the v-P relationships obtained during the six acceleration phases of the six sprints. An important finding of the present study was a strong linear relationship between individual optimal velocity (vopt) and individual maximal power output (Pmax) (n = 15, r = 0.95, P < 0.001) which has never been observed before. Since vopt has been demonstrated to be related to human fibre type composition both vopt, Pmax and their inter-relationship could represent a major feature in characterising muscle function in maximal unrestricted exercise. It is suggested that the present method is well suited to such analyses.     

The heart rate performance curve and left ventricular function during exercise in patients after myocardial infarction

PURPOSE: The aim of the study was to investigate the heart rate turn point (HRTP) in the time course of the heart rate performance curve (HRPC) in patients after myocardial infarction, and the relationship between the HRTP, the left ventricular function, and the second lactate turn point (LTP2). METHODS: We studied the degree and the direction of the HRPC and the left ventricular ejection fraction (LVEF) in 49 male patients 57 +/- 8 d after their first posterior wall infarction (MI). An incremental cycle ergometer test was performed and three phases of energy supply were defined (I: aerobic; II: aerobic-anaerobic transition; III: anaerobic) via blood lactate LA concentration. HRTP and LVEF-turn points (LVEFTP) were assessed by linear turn point analysis. The degree and direction of the deflection of HRPC were described as factor k (k > 0.1: downward deflection; -0.1 < k < 0.1: linear time curse; k < -0.1: upward deflection). The LVEF was determined by RNA. The difference between Pmax and LTP2 was calculated for LVEF (delta LVEF). RESULTS: An HRTP could be found in 44 and a LVEFTP in 47 cases. The HRTP occurred at 85 +/- 17 Watt (W), which correlated (r = 0.95; P < 0.001) with the LTP2 (84 +/- 17 W) and the LVEFTP (84 +/- 17 W, r = 0.93; P < 0.001). From LTP2 to Pmax a significant decrease in LVEF was found. There was a correlation between the percentage of HRmax at the HRTP and k (r = 0.70), as well as delta LVEF (r = 0.56). CONCLUSIONS: To prevent myocardial overloading, it seems to be useful to determine the HRTP, which indicate the workload where LVEF decreases.     

Multivariate analysis of muscular fatigue during bicycle ergometer exercise

The purpose of this study is to estimate the endurance threshold in terms of muscular fatigue during bicycle ergometer exercise. The problems to be solved are induced by dynamic movement and the physiological variation of muscle activity: that is, the progression and impairment of muscle activity occur simultaneously. First of all, we used multichannel recordings of myoelectric (ME) signals to reduce the effect by the movement of a bipolar surface electrode relative to the innervation zones. Second, since even the different types of ME parameters contain redundant information on muscular fatigue, we used the principal component analysis (PCA) to represent the meaningful information by small dimensions. Moreover, we proposed a total evaluation pattern to discriminate muscular fatigue from progression of muscle force at a glance. The total evaluation pattern shows the proportion of first principal component, the components of the first eigenvector, and the correlation coefficients as a function of the work load. The assessment using the total evaluation pattern divided eight subjects into three groups, whereas these subjects were not identified by a specific ME parameter.     

Wheelchair stability: effect of body position

When a wheelchair user reaches and leans, the static stability decreases in the direction of the lean and increases in the opposite direction. The purpose of this study was to determine the extent of this effect. We studied 21 nondisabled subjects in a representative wheelchair, measuring the static forward, rear, and lateral stability on a tilting platform. Reaching and leaning away from the tip added stability, with mean increases ranging from 9.1% to 124.3% of the neutral-position values, whereas reaching and leaning toward the tip reduced stability, with mean decreases ranging from 25.2% to 52.3% (p < 0.0001). The stability range ("away" minus "toward") varied from 52.4% to 149.5%. Reaching forward had a greater effect on stability than did reaching back or to the side. Wheelchair users with the ability to control their body positions can profoundly affect the stability of their wheelchairs, a factor that should be considered in wheelchair selection and training.     

Comparison of left ventricular function during interval versus steady-state exercise training in patients with chronic congestive heart failure

This study sought to assess the safety of interval exercise training in patients with chronic congestive heart failure (CHF) with respect to left ventricular (LV) function. For effective rehabilitation in CHF, both aerobic capacity and muscle strength need to be improved. We have previously demonstrated in both coronary artery bypass surgery and patients with CHF that interval exercise training (IET) offers advantages over steady-state exercise training (SSET). However, because LV function during IET has not yet been studied, the safety of this method in CHF remains unclear. To assess LV function during IET and SSET, at the same average power output, 11 patients with stable CHF were compared with 9 stable coronary patients with minimal LV dysfunction (control group). Using first-pass radionuclide ventriculography, changes in LV function were assessed during work versus recovery phases, at temporally matched times between the fifth and sixteenth minute of IET and SSET. In CHF during IET, there were no significant variations in the parameters measured during work and/or recovery phases. During the course of both IET and SSET, there was a significant increase in LV ejection fraction (5 vs 4 U; p <0.05 each), accompanied by increased heart rate (6 vs 8 beats/min; p <0.05 each) and cardiac output (2.4 vs 1.8 L/min; p <0.01 and p <0.05). In CHF, the magnitude of change in LV ejection fraction during IET was similar to that seen in controls. Both LV ejection fraction and the clinical status in patients with CHF remained stable during IET. Because IET appears to be as safe as SSET with respect to LV function, IET can be recommended for exercise training in CHF to apply higher peripheral exercise stimuli and with no greater LV stress than during SSET.     

Thoracocardiography: noninvasive monitoring of left ventricular stroke volume

PURPOSE: Thoracocardiography noninvasively monitors global stroke volume by inductive plethysmographic recording of ventricular volume curves as previously validated by thermodilution. Our purpose was to investigate the potential of thoracocardiography to individually assess stroke volume of the left ventricle. We hypothesized that curves predominantly reflecting left ventricular volume could be obtained by recording waveforms from thoracocardiographic transducers placed at various levels around the chest, and by identifying their origin as the left ventricle if mean expiratory exceeded mean inspiratory stroke volumes during spontaneous breathing. MATERIALS AND METHODS: Stroke volumes obtained by thoracocardiography in normal subjects were compared beat by beat with estimates derived from simultaneous measurements of left ventricular cavity stroke area by echocardiography with automatic boundary detection. Changes in respiratory variations of stroke volumes were analyzed during spontaneous breathing at fixed rate and tidal volume, during mechanical ventilation, and resistive loaded breathing. RESULTS: In 170 comparisons of beat-by-beat stroke volumes, 89% of thoracocardiographic fell within +/-20% of echocardiographic estimates. Changes in tidal volume, resistive loaded breathing, and mechanical ventilation induced respiratory variations of thoracocardiographic derived stroke volumes consistent with the known effect of respiratory changes in intrapleural pressure on left ventricular stroke volumes. CONCLUSIONS: The results suggest that thoracocardiography noninvasively tracks changes in left ventricular stroke volumes. Their absolute value may also be monitored if an initial calibration by an independent technique, such as echocardiography, is performed.     

Long-term effect of inducible silent ischaemia on left ventricular systolic function

A new method of thin section preparation of III-V semiconductors and multilayers for transmission electron microscopy (TEM) is presented that exhibits considerable advantages over conventional methods such as ion beam milling and jet thinning. GaAs thin films and multilayers of GaAs/In chi Ga1-chi As/GaAs are grown over an etch release layer of AlAs on GaAs substrates by molecular beam epitaxy (MBE). Planar TEM sections prepared by selective etching from these samples show improved ability to image film morphology and dislocation arrangements, and the resulting large thin electron transparent areas facilitate dislocation density measurements and detection of spatial variations. Avoidance of radiation effects and wedge shaping, both common to ion milled samples, allows this method to be used to prepare uniform thickness standards of single layer GaAs films for EDS analysis or lattice imaging.     

Prediction of maximum oxygen uptake during physical exercise on bicycle ergometer

Possibilities to predict maximum oxygen uptake (VO2max) during exercising on bicycle ergometer using the Russian Rating Perceived Exertion (RPE) was studied. Results of examination of 13 athletes demonstrate the possibility of predicting individual and group average VO2max on the basis of data from submaximum testing and the empirical formulas from the value of VO2max registered at RPE numbers 13 and 15. These VO2max values can serve as markers for assessing the dynamics of physical performance.     

Left ventricular function during exercise in athletes and in sedentary men

Galactose-1-phosphate uridyltransferase (GALT) is a key enzyme in the metabolism of galactose. GALT activates the galactose-glucose interconversion and enables the synthesis of glucose-1-phosphate and UDP-galactose (UDP-Gal). UDP-Gal is the galactosyl donor for the incorporation of galactose into complex oligosaccharides, glycoproteins and glycolipids. The expression of GALT was characterized both in vivo and in vitro during late embryonic and postnatal development of the brain and peripheral nerve of the rat. Assays of GALT mRNA and protein showed that it is weakly expressed during late embryonic development with a second peak of expression concomitant with myelinogenesis. GALT was prominently expressed in myelinating Schwann cells in a rat dorsal root ganglia culture system. GALT deficiency in humans results in galactosemia, a disease characterized by long-term intellectual impairment, and probably dysmyelination. The developmentally regulated pattern of GALT expression during maturation of the nervous system may provide a molecular basis for these neurological complications which seriously compromise the outcome of many galactosemic patients.     

One year of exercise training does not alter resting left ventricular systolic or diastolic function

This study tested the effects of light schedules on performance and yields of broiler chickens. In Experiment 1, light treatments during Days 1 to 49 of age were: 1) 23 h light (L):1 h dark (D); 2) 16L:8D;3) 16L: 3D:1L:4D; and 4) 16L:2D:1L:2D:1L:2D. In Experiment 2, Light Treatments 1 and 2 were the same as Treatments 1 and 4, respectively, in Experiment 1; 3) 23L:1D Days 1 to 7, 16L:8D Days 8 to 14, the light period was increased by 2 h/wk during Days 15 to 35, and 23L:1D Days 36 to 42; and 4) 23L:1D Days 1 to 7, 16L:8D Days 8 to 14, 16L:3D: 2L:3D Days 15 to 21, 16L:2D:4L:2D Days 22 to 28, 16L: 1D:6L:1D Days 29 to 35, and 23L:1D thereafter. In Experiment 1, BW was greater in Treatment 4 than Treatment 2 at 22 (708 vs 642 g) and 49 d (2,948 vs 2,797 g), percentage leg problems was lower in Treatments 2 to 4 (9, 10 and 6%, respectively) than in Treatment 1 (20%), and percentage Grade A was greater in Treatment 4 than Treatment 2 (60 vs 46%) at 49 d. In Experiment 2, BW was greater in Treatment 1 (692 g) than Treatments 3 (617 g) and 4 (620 g) at 21 d, and the incidence of tibial dyschondroplasia was lower in Treatment 2 (3.1%) than Treatment 3 (15.3%) at 42 d. There were no differences for mortality among treatments in either experiment.     

Doppler echocardiographic assessment of left atrial and left ventricular function during right bundle branch block]

Electrocardiographic, echocardiographic and Doppler echocardiographic studies were performed in 44 patients with coronary heart disease and complete right bundle branch block. The patients were found to have an impaired phase pattern of left ventricular systole and diastole as more prolonged length of its isometric relaxation and contraction, lower economic feasibility and efficiency of its contraction, moderate dilation and hypertrophy. Hemodynamic abnormalities in the left heart in these patients are closely correlate with the changes in the phase pattern of right ventricular systole and they turn out to be so greater as the degree of its hypertrophy is. In complete right bundle branch block, left ventricular pump dysfunction leads to decreased cardiac output and cardiac index, increased total peripheral vascular resistance, thus predisposing to impaired greater circulation.     

Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function

This article reviews diastolic and systolic ventricular interaction, and clinical pathophysiological conditions involving ventricular interaction. Diastolic ventricular interdependence is present on a moment-to-moment, beat-to-beat basis, and the interactions are large enough to be of physiological and pathophysiological importance. Although always present, ventricular interdependence is most apparent with sudden postural and respiratory changes in ventricular volume. Left ventricular function significantly affects right ventricular systolic function. Experimental studies have shown that about 20% to 40% of the right ventricular systolic pressure and volume outflow result from left ventricular contraction. This dependency of the right ventricle on the left ventricle helps to explain the right ventricular response to volume overload, pressure overload, and myocardial ischemia. The septum and its position are not the sole mechanism for ventricular interdependence. Ventricular interdependence causes overall ventricular deformation, and is probably best explained by the balance of forces at the interventricular sulcus, the material properties, and cardiac dimensions.