Reproducibility of left ventricular internal dimensions with M mode echocardiography: effects of heart size, body position and transducer angulation

Analysis was made of the variables of heart size, body position and transducer angle affecting the reproducibility of left ventricular internal dimensions as measured with M mode echocardiography. Echocardiograms were recorded in 24 subjects as the thorax was incrementally rotated and tilted. Transducer angle was noted from a three plane level attached to the probe. Constants were the technician, transducer placement and the interpreter. Heart rates varied insignificantly; respirations were held. Groups A and B were defined by their initial left ventricular internal dimensions at end-diastole (LVIDd): 49 +/- 5.9 and 73 +/- 8.6 mm (group mean +/- standard deviation). With body position constant the measurement error between duplicate recordings of LVIDd was +/- 1.2 mm (coefficient of variation = 1.8 percent) in Group A and +/- 4.5 mm (coefficient of variation = 4.6 percent) in Group B (p less than 0.001). Transducer angle varied 12 degrees between duplicate recordings in both groups. As the position of the thorax changed, the transducer followed, maintaining approximately the same incline with the chest wall. In both groups errors for combined LVIDd recorded with rotation and tilt, respectively, were unchanged from the duplication error. Thus, when the spatial orientation between the transducer and heart is held constant, it is the size of the heart that determines the reproducibility of the measurement of left ventricular internal dimensions.     

Nitric oxide and cGMP can produce either synaptic depression or potentiation depending on the frequency of presynaptic stimulation in the hippocampus

Nitric oxide (NO) has been suggested to play the role of retrograde messenger during long-term potentiation (LTP) in hippocampus. In support of this idea, NO induces LTP when paired with a weak tetanus (50 Hz). An additional criterion that has been proposed for NO being a retrograde messenger is that it should also elicit long-lasting enhancement when paired with low-frequency stimulation of the presynaptic fibers. In the present study, we have tested this prediction. We find that NO produces long-lasting depression rather than potentiation when paired with low-frequency stimulation (0.25 Hz). A similar long-lasting depression is produced by 8-Br-cGMP, a cGMP analog, suggesting that NO may produce its effect by activating soluble guanylyl cyclase. These results demonstrate that NO and cGMP modulate synaptic transmission in the hippocampus by frequency-dependent mechanisms, and suggest that NO is most suitable as a retrograde messenger for LTP when the presynaptic neuron fires at high frequencies. By contrast, carbon monoxide (CO) elicits long lasting enhancement at both low and high frequencies.     

Left ventricular diastolic function in hypertensive patients with unstable angina and single coronary artery disease

The present study was performed to investigate left ventricular diastolic (LVD) function in hypertensive patients with unstable angina. Three groups of 17 patients each were studied. Group 1 consisted of hypertensives with unstable angina (HTU); group 2, normotensives with unstable angina (NTU); and group 3, untreated, uncomplicated hypertensives (HT). The LVD function was assessed echocardiographically by transmitral valve Doppler flow to measure the ratio between the early diastolic filling (E) and the atrial contraction phase (A). An E/A ratio of < 1 was suggestive of LVD dysfunction. Left ventricular mass (LVM), from an M-mode echocardiogram using the Penn-Cube formula, was corrected to body surface area (LVM/S) using a standard nomogram. Data are represented as median values and analyzed by Mann-Whitney test. P was significant at < .05. The HTU group had an E/A ratio of 0.8, and the NTU and HT groups had ratios of 1.17 and 1.1, respectively. There was significant diastolic dysfunction in the HTU group compared with the NTU and HT groups (P = .037 and .049, respectively). Although the LVM/S was significantly higher in the HTU group when compared with the HT group (110.6 and 96.9, respectively, P = .017), there was no significant difference between the HTU and NTU groups (123.1), P = .67. Hypertensive patients with unstable angina have significant LVD dysfunction that seems to be independent of LVM and ischemia. This may be attributable to increased stiffness of the left ventricle or structural left ventricular abnormalities.