Sample records for cardiography

  1. The IMPACT shirt: textile integrated and portable impedance cardiography. (United States)

    Ulbrich, Mark; Mühlsteff, Jens; Sipilä, Auli; Kamppi, Merja; Koskela, Anne; Myry, Manu; Wan, Tingting; Leonhardt, Steffen; Walter, Marian


    Measurement of hemodynamic parameters such as stroke volume (SV) via impedance cardiography (ICG) is an easy, non-invasive and inexpensive way to assess the health status of the heart. We present a possibility to use this technology for monitoring risk patients at home. The IMPACT Shirt (IMPedAnce Cardiography Textile) has been developed with integrated textile electrodes and textile wiring, as well as with portable miniaturized hardware. Several textile materials were characterized in vitro and in vivo to analyze their performance with regard to washability, and electrical characteristics such as skin-electrode impedance, capacitive coupling and subjective tactile feeling. The small lightweight hardware measures ECG and ICG continuously and transmits wireless data via Bluetooth to a mobile phone (Android) or PC for further analysis. A lithium polymer battery supplies the circuit and can be charged via a micro-USB. Results of a proof-of-concept trial show excellent agreement between SV assessed by a commercial device and the developed system. The IMPACT Shirt allows monitoring of SV and ECG on a daily basis at the patient's home.

  2. Impedance cardiography signal denoising using discrete wavelet transform. (United States)

    Chabchoub, Souhir; Mansouri, Sofienne; Salah, Ridha Ben


    Impedance cardiography (ICG) is a non-invasive technique for diagnosing cardiovascular diseases. In the acquisition procedure, the ICG signal is often affected by several kinds of noise which distort the determination of the hemodynamic parameters. Therefore, doctors cannot recognize ICG waveform correctly and the diagnosis of cardiovascular diseases became inaccurate. The aim of this work is to choose the most suitable method for denoising the ICG signal. Indeed, different wavelet families are used to denoise the ICG signal. The Haar, Daubechies (db2, db4, db6, and db8), Symlet (sym2, sym4, sym6, sym8) and Coiflet (coif2, coif3, coif4, coif5) wavelet families are tested and evaluated in order to select the most suitable denoising method. The wavelet family with best performance is compared with two denoising methods: one based on Savitzky-Golay filtering and the other based on median filtering. Each method is evaluated by means of the signal to noise ratio (SNR), the root mean square error (RMSE) and the percent difference root mean square (PRD). The results show that the Daubechies wavelet family (db8) has superior performance on noise reduction in comparison to other methods.


    NARCIS (Netherlands)



    It is possible to accurately measure the left ventricular ejection time from the dZ/dt signal of impedance cardiography. The pre-ejection period can be measured from simultaneous recordings of ECG and dZ/dt. The thoracic admittance (reciprocal value of thoracic impedance) is the sum of a constant ti

  4. Non-invasive measurements of cardiac output in atrial fibrillation: Inert gas rebreathing and impedance cardiography

    DEFF Research Database (Denmark)

    Osbak, Philip S; Henriksen, Jens Henrik Sahl; Kofoed, Klaus F;


    Abstract Background. Atrial fibrillation (AF) is associated with significant morbidity and mortality. To test the effect of interventions, knowledge of cardiac output (CO) is important. However, the irregular heart rate might cause some methods for determination of CO to have inherent weaknesses....... Objective. To assess the validity of these methods in AF, a new inert gas rebreathing device and impedance cardiography was tested with echocardiography as reference. Methods. Using a cross-sectional design, 127 patients with AF and 24 in SR were consecutively recruited. Resting CO was measured using inert...... gas rebreathing (n = 62) or impedance measurement of intrathoracic blood flow (n = 89) in separate studies with echocardiographic measurement as reference. Results. CO determined with impedance cardiography was mean 4.77 L/min ± 2.24(SD) compared to 4.93 L/min ± 1.17 by echocardiography (n = 89, n...

  5. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J;


    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements...

  6. Various Electrode Configuration in Impedance Cardiography by a Three-dimensional Finite Element Model

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    Kim, D.W. [Yonsei Univ., Seoul (Korea, Republic of)


    In this study impedance changes due to aortic expansion, blood and lung resistivity changes during systole were calculated for various electrode configurations in impedance cardiography using a three-dimensional finite element thoracic model. For the aortic expansion the aorta between the potential electrodes in the model was expanded for the increase of blood volume, 30ml. The blood volume increase in aorta was calculated with the basal impedance(Z) and the impedance change({Delta}Z) found from the finite element code using the formula, vol={rho}(L/Z){sup 2}{Delta}Z relating impedance change and blood volume change. The aortic expansions were simulated for six electrode configurations including the conventional one and then the blood volumes were calculated using the formula above to investigate which one was closer to the actual blood velum increase of 30ml. It was calculated to be 24ml for the conventional configuration. For the other five ones, they were all closer to 30ml than the conventional one. From the results above it can be also concluded that the impedance change in impedance cardiography is approximately proportional to the blood volume change in large arteries. (author). 10 refs., 3 figs.

  7. Wavelet-based correlations of impedance cardiography signals and heart rate variability (United States)

    Podtaev, Sergey; Dumler, Andrew; Stepanov, Rodion; Frick, Peter; Tziberkin, Kirill


    The wavelet-based correlation analysis is employed to study impedance cardiography signals (variation in the impedance of the thorax z(t) and time derivative of the thoracic impedance (- dz/dt)) and heart rate variability (HRV). A method of computer thoracic tetrapolar polyrheocardiography is used for hemodynamic registrations. The modulus of wavelet-correlation function shows the level of correlation, and the phase indicates the mean phase shift of oscillations at the given scale (frequency). Significant correlations essentially exceeding the values obtained for noise signals are defined within two spectral ranges, which correspond to respiratory activity (0.14-0.5 Hz), endothelial related metabolic activity and neuroendocrine rhythms (0.0095-0.02 Hz). Probably, the phase shift of oscillations in all frequency ranges is related to the peculiarities of parasympathetic and neuro-humoral regulation of a cardiovascular system.

  8. Impedance cardiography for estimating cardiac output during submaximal and maximal work. (United States)

    Kobayashi, Y; Andoh, Y; Fujinami, T; Nakayama, K; Takada, K; Takeuchi, T; Okamoto, M


    Impedance cardiography was used to estimate cardiac output in 10 men during rest and within 5 s after exercise on a bicycle ergometer, including work up to and including maximal aerobic capacity. An indwelling venous catheter permitted simultaneous sampling of venous blood for observing changes in hematocrit associated with each exercise level. Cardiac output, calculated from a standard equation which assumes a constant value of 150 for the electrical resistivity of blood, was compared with corresponding calculations in which blood resistivity was individually determined as a function of hematocrit. It is concluded that many of the discrepancies in the literature related to values for cardiac output obtained during exercise by the impedance method may be inherent in calculations that do not consider the changing electrical resistivity of the blood with a changing hematocrit.

  9. A comparison of systolic time intervals measured by impedance cardiography and carotid pulse tracing

    DEFF Research Database (Denmark)

    Mehlsen, J; Bonde, J; Rehling, Michael;


    .001) and found that left ventricular ejection times were longer when determined by the carotid technique (p less than 0.01). We found a significant correlation between drug-induced changes in STI-variables measured by the two methods (p less than 0.001). Both methods had a high degree of reproducibility......The purpose of this study was to compare the systolic time intervals (STI) obtained by impedance cardiography and by the conventional carotid technique. This comparison was done with respect to: 1) correlations between variables obtained by the two methods, 2) ability to reflect drug......-induced changes, 3) reliability in terms of reproducibility and 4) heart rate dependency of the variables measured. The study included 25 unmedicated patients with ischaemic heart disease and 36 healthy subjects. We obtained significant correlations between STI-variables measured by the two methods (p less than 0...

  10. Cardiac output in exercise by impedance cardiography during breath holding and normal breathing. (United States)

    Du Quesnay, M C; Stoute, G J; Hughson, R L


    Estimation of cardiac output by impedance cardiography (QZ) in exercise during normal breathing (NB) has been limited by motion artifact. Our objective was to obtain readable impedance cardiograms on five subjects during upright cycle exercise at 0, 50, 100, 150, and 200 W to permit comparisons of QZ during NB, expiratory breath hold (EXP) and inspiratory breath hold (INSP). Q was also determined using an equilibration CO2 rebreathing method [Q(RB)]. QZ during NB exceeded EXP QZ at 100, 150, and 200 W, and exceeded INSP QZ at 100 W (P less than 0.05). The low EXP QZ values were due to a significantly lower stroke volume at 100, 150, and 200 W (P less than 0.05). For the INSP QZ at 100 W, heart rate was lower than during EXP (P less than 0.05). Regression of QZ (NB) against Q(RB) resulted in a linear relationship (r = 0.93) over the range of Q = 7-26 1/min. The slope of the regression differed significantly from 1.0 (P less than 0.05). We conclude that QZ values obtained during EXP or INSP should not be assumed to represent QZ during NB, at least at work rates greater than 50 W. A consequence of the linear relationship between QZ(NB) and Q(RB) over the range of 0-200 W is that estimates of CO2 rebreathing cardiac output can be obtained by impedance cardiography if QZ is adjusted using an appropriate empirical factor.

  11. Signal processing technique for non-invasive real-time estimation of cardiac output by inductance cardiography (thoracocardiography). (United States)

    Bucklar, G B; Kaplan, V; Bloch, K E


    Inductance cardiography (thoracocardiography) non-invasively monitors changes in stroke volume by recording ventricular volume curves with an inductive plethysmographic transducer encircling the chest at the level of the heart. Clinical application of this method has been hampered, as data analysis has not been feasible in real time. Therefore a novel, real-time signal processing technique for inductance cardiography has been developed. Its essential concept consists in performance of multiple tasks by several, logically linked signal processing modules that have access to common databases. Based on these principles, a software application was designed that performs acquisition, display, filtering and ECG-triggered ensemble averaging of inductance signals and separates cardiogenic waveforms from noise related to respiration and other sources. The resulting ventricular volume curves are automatically analysed. Performance of the technique for monitoring cardiac output in real time was compared with thermodilution in four patients in an intensive care unit. The bias (mean difference) among 76 paired thoracocardiographic and thermodilution derived changes in cardiac output was 0%; limits of agreement (+/- 2 SD of the bias) were +/- 25%. It is concluded that the proposed signal processing technique for inductance cardiography holds promise for non-invasive, real-time estimation of changes in cardiac output.

  12. Textrode-enabled transthoracic electrical bioimpedance measurements - towards wearable applications of impedance cardiography

    Directory of Open Access Journals (Sweden)

    Juan Carlos Márquez Ruiz


    Full Text Available During the last decades the use of Electrical Bioimpedance (EBI in the medical field has been subject of extensive research, especially since it is an affordable, harmless and non-invasive technology. In some specific applications such as body composition assessment where EBI has proven a good degree of effectiveness and reliability, the use of textile electrodes and measurement garments have shown a good performance and reproducible results. Impedance Cardiography (ICG is another modality of EBI that can benefit from the implementation and use of wearable sensors. ICG technique is based on continuous impedance measurements of a longitudinal segment across the thorax taken at a single frequency. The need for specific electrode placement on the thorax and neck can be easily ensured with the use of a garment with embedded textile electrodes, textrodes. The first step towards the implementation of ICG technology into a garment is to find out if ICG measurements with textile sensors give a good enough quality of the signal to allow the estimation of the fundamental ICG parameters. In this work, the measurement performance of a 2-belt set with incorporated textrodes for thorax and neck was compared against ICG measurements obtained with Ag/AgCl electrodes. The analysis was based on the quality of the fundamental ICG signals (∆Z, dZ/dt and ECG, systolic time intervals and other ICG parameters. The obtained results indicate the feasibility of using textrodes for ICG measurements with consistent measurements and relatively low data dispersion. Thus, enabling the development of measuring garments for ICG measurements.

  13. Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography

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    Mathur Sharad


    Full Text Available Objective: Vasoconstrictors are one of the therapeutic modalities in the treatment of septic shock. In the present study, we have compared the effects of dopamine and norepinephrine in the treatment of septic shock with pre-defined end-points and continuous non-invasive cardiac output monitoring using impedance cardiography. Design: Randomized controlled trial. Settings: Sixteen-bedded mixed intensive care unit of a tertiary care teaching institution. Materials and Methods: The study included 50 consecutive patients presenting with septic shock and divided randomly into two groups with 25 patients in each group. Group I patients were treated with dopamine and those in Group II were treated with norepinephrine. They were optimized with fluid resuscitation upto CVP>10 cm of H 2 O, packed red cells transfusion upto hematocrit> 30, oxygenation and ventilation upto PaO 2 >60 mmHg before the inotropes were started. The goal of therapy was to achieve and maintain for six hours, all of the following: (1 SBP> 90 mm Hg, (2 SVRI> 1100 dynes.s/cm 5 m 2 , (3 Cardiac Index> 4.0L/min/m 2 , (4 IDO 2 > 550 ml/min/m 2 and (5 IVO 2 > 150 ml/min/m 2 . Measurements: The demographic data, baseline parameters and post-treatment parameters were statistically analyzed by using t-test. Results: The post-treatment parameters were statistically significant showing the superiority of norepinephrine over dopamine in optimization of hemodynamics and patient survival. Significant improvement in systolic blood pressure, heart rate, cardiac index, SVRI, IVO 2 and urine output were found in norepinephrine group than the dopamine group. Dopamine showed a response in 10 out of 25 patients up to a maximum dose of 25 mcg/kg/min while with norepinephrine, 19 patients responded up to a maximum dose of 2.5 mcg/kg/min The hemodynamic parameters were preserved in norepinephrine group with better preservation of organ perfusion and oxygen utilization with maintenance of splanchnic and

  14. Impedance cardiography: Pulsatile blood flow and the biophysical and electrodynamic basis for the stroke volume equations

    Directory of Open Access Journals (Sweden)

    Donald P Bernstein


    Full Text Available Impedance cardiography (ICG is a branch of bioimpedance pimarily concerned with the determination of left ventricular stroke volume (SV. As implemented, using the transthoracic approach, the technique involves applying a current field longitudinally across a segment of thorax by means of a constant magnitude, high frequency, low amplitude alternating current (AC. By Ohm's Law, the voltage difference measured within the current field is proportional to the electrical impedance Z (Ω. Without ventilatory or cardiac activity, Z is known as the transthoracic, static base impedance Z0. Upon ventricular ejection, a characteristic time dependent cardiac-synchronous pulsatile impedance change is obtained, ΔZ(t, which, when placed electrically in parallel with Z0, constitutes the time-variable total transthoracic impedance Z(t. ΔZ(t represents a dual-element composite waveform, which comprises both the radially-oriented volumetric expansion of and axially-directed forward blood flow within both great thoracic arteries. In its majority, however, ΔZ(t is known to primarily emanate from the ascending aorta. Conceptually, commonly implemented methods assume a volumetric origin for the peak systolic upslope of ΔZ(t, (i.e. dZ/dtmax, with the presumed units of Ω·s-1. A recently introduced method assumes the rapid ejection of forward flowing blood in earliest systole causes significant changes in the velocity-induced blood resistivity variation (Δρb(t, Ωcm·s-1, and it is the peak rate of change of the blood resistivity variation dρb(t/dtmax (Ωcm·s-2 that is the origin of dZ/dtmax. As a consequence of dZ/dtmax peaking in the time domain of peak aortic blood acceleration, dv/dtmax (cm·s-2, it is suggested that dZ/dtmax is an ohmic mean acceleration analog (Ω·s-2 and not a mean flow or velocity surrogate as generally assumed. As conceptualized, the normalized value, dZ/dtmax/Z0, is a dimensionless ohmic mean acceleration equivalent (s-2

  15. Instrumentation in ultrasound cardiography

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    Swamy VMK


    Full Text Available Cardiac ultrasound/Echocardiography is a. simple, safe and non-invasive method for detecting heart diseases. When combined with ECG, X-ray and isotopic studies, ultrasound provides signifi-cant diagnostic information not previously available. M-Mode technique gives a unidimensional representation of movements of various structures of the heart whereas stop-action imaging or real time imaging gives a clear two-dimensional view of the various sections of the heart, thus permitting a comparison of anatomical juxta-positioning and continuity.

  16. Impedance plethysmography of thoracic region: impedance cardiography.

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    Deshpande A


    Full Text Available Impedance plethysmograms were recorded from thoracic region in 254 normal subjects, 183 patients with coronary artery disease, 391 patients with valvular heart disease and 107 patients with congenital septal disorder. The data in 18 normal subjects and 55 patients showed that basal impedance decreases markedly during exercise in patients with ischaemic heart disease. Estimation of cardiac index by this technique in a group of 99 normal subjects has been observed to be more consistent than that of the stroke volume. Estimation of systolic time index from impedance plethysmograms in 34 normal subjects has been shown to be as reliable as that from electrocardiogram, phonocardiogram and carotid pulse tracing. Changes in the shape of plethysmographic waveform produced by valvular and congenital heart diseases are briefly described and the role of this technique in screening cardiac patients has been highlighted.

  17. Effect Evaluation of Exogenous H2 S on Cardiac Function in Rats with Diabetic Cardiomyopathy by Echo-cardiography%超声心动图评价外源性硫化氢对糖尿病心肌病大鼠心功能的影响

    Institute of Scientific and Technical Information of China (English)

    房城; 郑秀茜; 刘永武; 赵良友; 刘树民


    目的:采用超声心动图来检测外源性硫化氢(H2 S)对糖尿病大鼠心功能的影响.方法:将SD大鼠随机分为对照组、模型组和治疗组,每组5只.一次性腹腔注射链脲佐菌素(STZ)制备糖尿病大鼠模型.治疗组腹腔注射NaHS,对照组和模型组给予等量生理盐水.12周后通过超声心动图进行检测.结果:与模型组比较,治疗组的收缩期室间隔厚度(IVSd)、舒张期室间隔厚度(IVSs)、收缩期左室内径(LVIDs)和舒张期左室后壁厚度(LVPWd)明显降低(P<0.01),收缩期左室后壁厚度(LVPWs)明显降低(P<0.05),治疗组心功能指标射血分数(EF)和缩短分数(FS)明显升高(P<0.01).结论:通过超声心动图证明,外源性H2 S能够有效减少糖尿病心肌病大鼠心肌重构,改善糖尿病心肌病大鼠心功能.%Objective:To evaluate the effect of exogenous H2 S on cardiac function in rats with diabetic cardiomyopathy by echo-cardiography. Methods:SD rats were randomly divided into the normal control group, the model group and the treatment group ( 5 ones in each) . Diabetic cardiomyopathy models were made by single intraperitoneal injection of streptozotocin ( STZ) . The treatment group was given intraperitoneal injection of NaHS, the control group and the model group was both given intraperitoneal injection of sa-line solution. The effect of exogenous H2 S on the cardiac function in the rats was evaluated by echocardiography after 12 weeks. Re-sults:Compared with those in the model group, IVSd, IVSs, LVIDs and LVPWd were much smaller in the treatment group ( P<0. 01), LVPWs was much smaller as well (P<0. 05), and EF and FS were improved significantly (P<0. 01). Conclusion:Exoge-nous H2 S can improve the heart function and reduce the myocardial remodeling in rats with diabetic cardiomyopathy.

  18. 4D embryonic cardiography using gated optical coherence tomography (United States)

    Jenkins, M. W.; Rothenberg, F.; Roy, D.; Nikolski, V. P.; Hu, Z.; Watanabe, M.; Wilson, D. L.; Efimov, I. R.; Rollins, A. M.


    Simultaneous imaging of very early embryonic heart structure and function has technical limitations of spatial and temporal resolution. We have developed a gated technique using optical coherence tomography (OCT) that can rapidly image beating embryonic hearts in four-dimensions (4D), at high spatial resolution (10-15 μm), and with a depth penetration of 1.5 - 2.0 mm that is suitable for the study of early embryonic hearts. We acquired data from paced, excised, embryonic chicken and mouse hearts using gated sampling and employed image processing techniques to visualize the hearts in 4D and measure physiologic parameters such as cardiac volume, ejection fraction, and wall thickness. This technique is being developed to longitudinally investigate the physiology of intact embryonic hearts and events that lead to congenital heart defects.

  19. The Initial Systolic Time Interval in patients with spinal cord injury measured with impedance cardiography (United States)

    Hoekstra, Femke; Martinsen, Ørjan G.; Verdaasdonk, Rudolf M.; Janssen, Thomas W. J.; Meijer, Jan H.


    The Initial Systolic Time Interval (ISTI), obtained from the electrocardiogram and impedance cardiogram, is considered to be a measure for the time delay between the electrical and mechanical activity of the heart. This time delay is influenced by the sympathetic nerve system. Therefore, an observational study was performed in a group of patients (SCI) with spinal cord injuries. The relationship between the ISTI and the total heart cycle (RR-interval) was established by varying the RR-interval using an exercise stimulus to increase the heart rate. The slope of this relationship was observed to be significantly higher in the SCI-group as compared with a control group, although there was no difference in ISTI in the range of common heart rates during the test between the groups. This slope and the ISTI was observed to be significantly different in an acute patient having a recent spinal cord injury at a high level. Because of the variety in injury levels and incompleteness of the injuries further, more specific research is necessary to draw decisive conclusions with respect to the contribution of autonomic nervous control on the ISTI in SCI, although the present observations are notable.

  20. Method to measure autonomic control of cardiac function using time interval parameters from impedance cardiography

    NARCIS (Netherlands)

    Meijer, J.H.; Boesveldt, S.; Elbertse, E.; Berendse, H.W.


    The time difference between the electrocardiogram and impedance cardiogram can be considered as a measure for the time delay between the electrical and mechanical activities of the heart. This time interval, characterized by the pre-ejection period (PEP), is related to the sympathetic autonomous ner

  1. The effect of peripheral resistance on impedance cardiography measurements in the anesthetized dog. (United States)

    Critchley, Lester A H; Peng, Zhi Y; Fok, Benny S; James, Anthony E


    In the vasodilated and septic patient, the impedance method of measuring cardiac output (CO) may underestimate the true value. In this study, we sought to determine whether impedance CO (COIC) measurements are influenced by total peripheral resistance (TPR). In eight anesthetized and ventilated dogs, a high-precision flowprobe was placed on the ascending aorta, and direct CO was measured (CO flowprobe (COFP)). Mean arterial blood pressure was measured from the femoral artery. Simultaneous COIC measurements were made. TPR (mean arterial blood pressure x 80/COFP) was varied over 1-2 h by using infusions of phenylephrine and adrenaline and inhaled halothane. The bias between methods of CO measurement (COIC-COFP) was calculated and compared with TPR by using correlation and regression analysis. A total of 547 pairs of CO measurements were collected from the 8 dogs as TPR was varied. COFP changed by a mean of 190% (range, 89%-425%), and TPR changed by a mean of 266% (range, 94%-580%) during the experiment. The impedance method underestimated CO when TPR was low and overestimated CO when TPR was high. There was a logarithmic relationship between the CO bias and TPR. Correlation coefficients (r) between the CO bias and TPR ranged from 0.46 to 0.89 (P TPR halved or doubled. This finding explains the poor agreement between COIC and other methods of CO measurement found in validation studies involving critically ill patients.

  2. Impedance cardiography using band and regional electrodes in supine, sitting, and during exercise. (United States)

    Patterson, R P; Wang, L; Raza, S B


    The electrical impedance and its first derivative (dZ/dt) were measured at 100 kHz on 10 normal males in supine, sitting, and during upright bicycle exercise in order to compare the contribution of regional electrodes to the standard band electrode signal and to evaluate the possible use of spot electrodes for stroke volume (SV) measurements. Simultaneous measurements were made from band electrodes placed around the neck and lower thorax and from spot electrodes which recorded signals from the neck, upper thorax, and lower thorax. The results showed that approximately equal parts of the dZ/dt waveform came from the neck and upper thorax with the lower thorax contribution small but providing important features of the band signal. Changing from supine to sitting showed percentage decreases of 35% and 46% for the band and neck signals, respectively, with an increase of 19% for the upper thorax signal. The percentage increases in SV with upright exercise were 34%, 52%, and 24% for the bands, neck, and upper thorax signals, respectively. Band signal is made up of different signals from various regions of the thorax. Its ability to predict correct changes in SV may result from some "lucky" coincidences. The use of regional electrodes will probably not give the same SV information but may be important in measuring regional activities of the central circulation.

  3. Assessing cardiac preload by the Initial Systolic Time Interval obtained from impedance cardiography

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    Jan H Meijer


    Full Text Available The Initial Systolic Time Interval (ISTI, obtained from the electrocardiogram (ECG and impedance cardiogram (ICG, is considered to be a measure for the time delay between the electrical and mechanical activity of the heart and reflects an early active period of the cardiac cycle. The clinical relevance of this time interval is subject of study. This paper presents preliminary results of a pilot study investigating the use of ISTI in evaluating and predicting the circulatory response to fluid administration in patients after coronary artery bypass graft surgery, by comparing ISTI with cardiac output (CO responsiveness. Also the use of the pulse transit time (PTT, earlier recommended for this purpose, is investigated. The results show an inverse relationship between ISTI and CO at all moments of fluid administration and also an inverse relationship between the changes ΔISTI and ΔCO before and after full fluid administration. No relationships between PTT and CO or ΔPTT and ΔCO were found. It is concluded that ISTI is dependent upon preload, and that ISTI has the potential to be used as a clinical parameter assessing preload.

  4. Evaluation of left-to-right shunts in adults with atrial septal defect using first-pass radionuclide cardiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Aldershvile, J; Svendsen, Jesper Hastrup;


    outputs of the right and left ventricle was 0.04 l.min-1, the limits of agreement -0.80 to 0.88 l.min-1 and the 95% confidence interval for the bias -0.14 to 0.22 l.min-1. Right-sided cardiac catheterization was performed to assess the severity of the arterio-venous shunt by oximetry in 18 adult patients...

  5. Diagnostic value of admittance pneumography combining with admittance cardiography for assessing left ventricular diastolic function%肺、心导纳血流图联合应用对左室舒张功能的诊断价值

    Institute of Scientific and Technical Information of China (English)

    周万兴; 郑亚丽; 陆蕙; 陈桐生


    目的是以核素心室造影(简称:心血池)的PFR(峰充盈率)及LVEF(左室射血分数)为对照,探讨心、肺导纳图联合应用对左室舒张功能的诊断价值.方法118例研究对象包括健康对照30人(男性18人,女性12人,平均年龄54.4岁±7.8岁);高血压和/或冠心病(心绞痛、陈旧心梗)病人89人,后者依心血池的PFR及LVEF结果分为:心功能正常组(PFR≥2.0,LVEF≥50%)19人(男12人,女7人,平均年龄54.8岁±8.9岁);单纯舒张功能障碍组(PFR<2.0,LVEF≥50%)30人(男19人,女¨人,平均年龄54.1岁±8.8岁);舒张及收缩功能障碍组(PFR<2.0,LVEF<50%)39人(男24人,女15人,平均年龄54.4岁±9.7岁).99mTcPYp示踪剂,平衡法测LVEF、PFR、HR.同一天内进行机测心导纳的LVEF、肺导纳的Ha(房缩波a波高度)、HS(室宿波S波高度)、HD(室舒波D波高度)、Ha/HS和HD/HS比值.比较病人各组各参数与健康对照组的差别,肺导纳各参数与PFR的相关系数,心、肺导纳图联合应用对左室功能的诊断符合率.结果①与健康对照组相应参数比较,心功能障碍的病人组Ha、HD、Ha/HS、HD/HS均明显增高.②全部研究对象的Ha、HD、Ha/HS、HD/HS与PFR呈负相关分别为-0.693,-0.457,-0.770,-0.793(P<0.01),其中,以HD/HS相关性最高,Ha/HS次之,Ha、HD较低,HS则相关性不明显.③以大于等于健康对照组相应参数均值加2个标准差为筛查标准,显示:Ha、HD、Ha/HS、HD/HS与PFR(≥2.0或<2.0)的诊断符合率分别为84.7%,52.5%,88.1%和82.2%;HD/HS+心导纳的EF、Ha/HS+心导纳的EF与心血池PFR+LVEF的诊断符合率分别为81.4%,86.4%;HD/HS在单纯舒张功能障碍组符合率较高(90%vs Ha/HS的70%),Ha/HS在合并收缩功能障碍组较高(100% vs HD/HS的61.5%),引入心导纳图的LVEF后情况也相似.结论肺导纳图的Ha/HS、HD/HS与核素心室造影的PFR有较好的相关性,Ha/HS、HD/HS联合心导纳图的LVEF对左室舒张功能的诊断与核素法的诊断之间有较高的符合率,而且其设备要求简单,费用不高,利于基层推广应用.

  6. What can functional imaging do for cardiology?

    Energy Technology Data Exchange (ETDEWEB)

    Lucignani, G. [Milan Univ. (Italy). Scientific Institute H S. Raffele, Dept. of Nuclear Medicine


    New technologies including echo-cardiography and magnetic resonance imaging have been developed and their use validated for cardiology by comparison with nuclear studies. The size of market will influence significantly the industrial strategies of the future. The future of nuclear medicine is related to technological, methodological, biochemical, physiological and clinical expertise of the nuclear medicine physicians.

  7. Studies of Tissue Perfusion Failure at LAC+USCMC and the Incorporation of the Results into a National Trauma Database (United States)


    17–19). Limitations of the impedance cardiography are dysrhythmias, pulmonary edema , pleural effusion, hemothorax, excessive crystalloid infusions...was reported to improve outcome in peripheral vascular surgery (19), trauma (20), cardiogenic shock (21, 22), and sepsis (23). Recently, Rivers et al...impedance method include faulty electrode placement, motion artifacts, restlessness, shivering, pulmonary edema , pleural effusion, valvular heart disease

  8. Combined first pass and equilibrium radionuclide cardiographic determination of stroke volume for quantitation of valvular regurgitation

    DEFF Research Database (Denmark)

    Kelbaek, H; Aldershvile, J; Svendsen, Jesper Hastrup


    A new noninvasive procedure for quantitation of cardiac valve regurgitation was evaluated using a combination of first pass and gated equilibrium radionuclide cardiography in 38 subjects with and without cardiac valve disease. Left-sided cardiac catheterization was performed to determine the seve......A new noninvasive procedure for quantitation of cardiac valve regurgitation was evaluated using a combination of first pass and gated equilibrium radionuclide cardiography in 38 subjects with and without cardiac valve disease. Left-sided cardiac catheterization was performed to determine...... with mild mitral incompetence and 2+ aortic regurgitation, 37% in patients with moderate mitral incompetence and 3+ aortic regurgitation and 57% in patients with severe mitral incompetence and 4+ aortic regurgitation. These findings suggest that combined first pass and gated equilibrium radionuclide...

  9. Effects of alpha-adrenoceptor and of combined sympathetic and parasympathetic blockade on cardiac performance and vascular resistance

    DEFF Research Database (Denmark)

    Kelbaek, H; Frandsen, Henrik Lund; Hilsted, J


    1. Cardiac performance and vascular resistance was studied in seven healthy men by radionuclide cardiography and venous plethysmography before and after alpha-adrenoceptor blockade with phentolamine and after combined alpha-adrenoceptor, beta-adrenoceptor (propranolol) and parasympathetic (atropine...... propranolol and atropine were added. 3. These results indicate that peripheral vasoconstriction especially that exerted by alpha-adrenoceptor nervous tone in skeletal muscle restricts left ventricular emptying of the intact heart. During pharmacologic blockade of the sympathetic and parasympathetic nervous...

  10. The Longitudinal Health Study: A Multiphasic Medical Surveillance Program for U. S. Navy Submarine and Diving Personnel (United States)


    some insight into disease prevalence within the specialized popu- lations being studied . A mechanism has yet to be established to ensure the...1/3 surface. Soft debris < 2/3 surface. Soft debris •> 2/3 surface. VI. Periodontal Disease Index (Modified Ramfjord Index): A. Pocket or Sulcus... epidemiologic study . While the value of computer electro- cardiography is easily recognized, ap- propriate software has not yet been available at our

  11. Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

    DEFF Research Database (Denmark)

    Faber, J; Wiinberg, N; Schifter, S;


    rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T4) and tri-iodothyronine (T3) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography......) in subjects with endogenous subclinical hyperthyroidism in order to elucidate whether these patients had signs of excess thyroid hormone at the tissue level.......Hyperthyroidism has profound effects on the cardiovascular system, including reduced systemic vascular resistance (SVR) due to relaxation of vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart...

  12. An NLMS algorithm with optimized preparatory step-size parameters for SQUID-based MCG data processing

    Institute of Scientific and Technical Information of China (English)

    Li Zhuo; Chen Geng-Hua; Zhang Li-Hua; Yang Qian-Sheng; Feng Ji


    We present a new least-mean-square algorithm of adaptive filtering to improve the signal to noise ratio for magneto-cardiography data collected with high-temperature SQUID-based magnetometers. By frequently adjusting the adaptive parameter a to systematic optimum values in the course of the programmed procedure, the convergence is accelerated with a highest speed and the minimum steady-state error is obtained simultaneously. This algorithm may be applied to eliminate other non-steady relevant noises as well.

  13. Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

    DEFF Research Database (Denmark)

    Faber, J; Wiinberg, N; Schifter, S


    Hyperthyroidism has profound effects on the cardiovascular system, including reduced systemic vascular resistance (SVR) due to relaxation of vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart...... rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T4) and tri-iodothyronine (T3) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography......) in subjects with endogenous subclinical hyperthyroidism in order to elucidate whether these patients had signs of excess thyroid hormone at the tissue level....

  14. Hemodynamic function of the standard St. Jude bileaflet disc valve has no clinical impact 10 years after aortic valve replacement

    DEFF Research Database (Denmark)

    Lund, Ole; Dorup, Inge; Emmertsen, Kristian


    in the survivors of a prospective series 10 years after AVR for aortic stenosis. DESIGN: Forty-three survivors aged 32-90 years from a prospective series attended a follow-up study with Doppler echo and radionuclide cardiography 10 years after AVR for aortic stenosis. Six patients with significant left sided valve...... regurgitation were excluded from further analysis: they had significantly lower St. Jude valve gradient and left ventricular ejection fraction (LVEF) and larger mass index (LVMi) than 37 without. RESULTS: In the 37 patients without left sided valve regurgitation peak and mean gradients were inversely related...... to St. Jude valve geometric orifice area (GOA) indexed for either body surface area or left ventricular end-diastolic dimension (LVEDD). The gradients correlated directly with LVEDD but not with LVEF or LVMi. Eleven patients with hypertension had higher peak gradients (31+/-13 versus 22+/-8 mmHg, p

  15. Type-specific orthostatic hemodynamic response of hypertensive diseases in pregnancy. (United States)

    Staelens, Anneleen S; Vonck, Sharona; Mesens, Tinne; Tomsin, Kathleen; Molenberghs, Geert; Gyselaers, Wilfried


    Posture changes may differ between types of hypertensive disease. The aim is to evaluate the orthostatic response of impedance cardiography (ICG) measurements in uncomplicated and hypertensive pregnancies. Measurements were performed in supine and standing position in 202 women: 41 uncomplicated pregnancies (UP), 59 gestational hypertension (GH), 35 early-onset (EPE, hypertensive complicated gestations in the orthostatic change of the aortic acceleration. In contrast to patients with preeclampsia, those with GH had an increased blood pressure and Heather index, and stable pre-ejection period after posture change. EPE differed from LPE by change in blood pressure and aortic flow parameters. In addition to static ICG-measurements, orthostatic shifts improved group characterization from 57.4% to 65.8%. The orthostatic response is altered in hypertensive pregnancies. ICG measurements in the upright as well as during an orthostatic test might have the potential to improve the discriminative yield between hypertensive diseases in pregnancy.

  16. A High-Sensitivity Tunable Two-Beam Fiber-Coupled High-Density Magnetometer with Laser Heating

    Directory of Open Access Journals (Sweden)

    Igor Savukov


    Full Text Available Atomic magnetometers (AM are finding many applications in biomagnetism, national security, industry, and science. Fiber-coupled (FC designs promise to make them compact and flexible for operation. Most FC designs are based on a single-beam configuration or electrical heating. Here, we demonstrate a two-beam FC AM with laser heating that has 5 fT/Hz1/2 sensitivity at low frequency (50 Hz, which is higher than that of other fiber-coupled magnetometers and can be improved to the sub-femtotesla level. This magnetometer is widely tunable from DC to very high frequencies (as high as 100 MHz; the only issue might be the application of a suitable uniform and stable bias field with a sensitivity under 10 fT/Hz1/2 and can be used for magneto-encephalography (MEG, magneto-cardiography (MCG, underground communication, ultra-low MRI/NMR, NQR detection, and other applications.

  17. Fabrication and characterization of a MEMS nano-Tesla ferromagnetic-piezoelectric magnetic sensor array (United States)

    Qu, Peng; Gollapudi, Sreenivasulu; Bidthanapally, Rao; Srinivasan, Gopalan; Petrov, Vladimir; Qu, Hongwei


    A self-biased MEMS magnetic sensor array with ferromagnetic-piezoelectric composites has been fabricated and characterized. The array with two Quartz-Nickel-Metglas cantilevers with nano-tesla sensitivity was fabricated by MEMS processes including silicon-quartz low temperature bonding, quartz wafer thinning, and electroplating of thick nickel thin films. Under self-biasing due to magnetization grading of ferromagnetic layer, magnetoelectric coefficients of 6.6 and 5.6 V/cm Oe and resolutions of ˜0.58 and ˜0.75 nT are obtained at the mechanical resonant frequencies of 191.5 and 184.8 Hz for the two sensors in the array, respectively. Such arrays have the potential for applications in biomagnetic imaging technologies including magneto-cardiography.

  18. Vagal regulation and internalizing psychopathology among adolescents exposed to childhood adversity. (United States)

    McLaughlin, Katie A; Alves, Sonia; Sheridan, Margaret A


    Childhood adversity (CA) is strongly associated with youth psychopathology. Identifying factors that reduce vulnerability following CA is critical for developing preventive interventions. Vagal tone and vagal reactivity following psychosocial stressors might influence psychopathology among youths exposed to CA. We acquired heart period and impedance cardiography data to calculate respiratory sinus arrhythmia (RSA) and preejection period (PEP) from 157 adolescents aged 13-17 years at rest and during the Trier Social Stress Test (TSST). Internalizing and externalizing symptoms and multiple forms of CA were assessed. Resting RSA and RSA reactivity interacted with CA in predicting internalizing but not externalizing psychopathology; CA was unassociated with internalizing problems in adolescents with high resting RSA and RSA reactivity. No interactions were observed with PEP. High resting RSA predicted greater vagal rebound and accelerated heart rate recovery following the TSST, highlighting one potential mechanism underlying low internalizing symptoms following CA among youths with high vagal tone.

  19. Echocardiographic Partition Values and Prevalence of Left Ventricular Hypertrophy in Hypertensive Jamaicans

    Directory of Open Access Journals (Sweden)

    Chiranjivi Potu


    Full Text Available Left ventricular hypertrophy (LVH detected by either electrocardiography or echo- cardiography has been shown to be an extremely strong predictor of morbidity and mortality in patients with essential hypertension and in members of the general population. Alternative to LVH, left ventricular geometrical patterns offer incremental prognostic value beyond that provided by the other cardiovascular risk factors including left ventricular mass (LVM. Combination of LVM and relative wall thickness (RWT can be used to identify different left ventricular geometrical patterns. Various indexation methods normalised for LVM have been shown to offer prognostic significance. There was no prior study on the prevalence of LVH and geometric patterns in hypertensive patients in Jamaica using multiple partition values. Our study was designed to estimate the prevalence of LVH and geometrical patterns in a hypertensive Caribbean population in Jamaica using 10 different published cut-off values.

  20. Peripartum heart disease in cows. (United States)

    Yamagishi, N; Okada, H; Koiwa, M; Kudo, K; Matsuo, N; Naito, Y


    Thirteen Holstein dairy cows aged 5.1-10.6 years died or were killed as a result of severe illness during the peripartum period, associated with lateral recumbency, moaning, tachycardia and dyspnoea. They were all high milk producers (> 9000 kg/year) and had experienced at least three pregnancies. The average duration of the clinical course was 2.5 +/- 1.7 days. Electro-cardiography revealed marked tachycardia associated with atrial fibrillation or atrioventricular dissociation. Serum clinical chemistry showed severe hypocalcaemia (3.6 +/- 1.3 mg/dl) and at necropsy multifocal myocardial necrosis was invariably found. Myocardial necrosis was accompanied by neutrophilic and mononuclear cellular infiltrates with interstitial fibrosis. The cause of this lesion was not established.

  1. A High-Sensitivity Tunable Two-Beam Fiber-Coupled High-Density Magnetometer with Laser Heating. (United States)

    Savukov, Igor; Boshier, Malcolm G


    Atomic magnetometers (AM) are finding many applications in biomagnetism, national security, industry, and science. Fiber-coupled (FC) designs promise to make them compact and flexible for operation. Most FC designs are based on a single-beam configuration or electrical heating. Here, we demonstrate a two-beam FC AM with laser heating that has 5 fT/Hz(1/2) sensitivity at low frequency (50 Hz), which is higher than that of other fiber-coupled magnetometers and can be improved to the sub-femtotesla level. This magnetometer is widely tunable from DC to very high frequencies (as high as 100 MHz; the only issue might be the application of a suitable uniform and stable bias field) with a sensitivity under 10 fT/Hz(1/2) and can be used for magneto-encephalography (MEG), magneto-cardiography (MCG), underground communication, ultra-low MRI/NMR, NQR detection, and other applications.

  2. Berardinelli–Seip syndrome type 2 – An Egyptian child

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky


    Full Text Available We report a 2.5 year old male, first in order of birth of first cousin consanguineous parents with the typical features of Berardinelli–Seip congenital lipodystrophy 2 (BSCL2 since birth with moderate mental retardation. He had generalized lipodystrophy with various dermatologic and systemic manifestations. The patient looked older than his age with the loss of buccal pad of fat, hypertrichosis mainly on the back and lower limbs, thick scalp hair, mild prognathism, large hands and feet with prominent joints and muscular hypertrophy. Acanthosis nigricans was evident over the neck and both axillae inspite of the normal level of sugar and insulin. The abdomen was markedly prominent with mild hepatosplenomegaly and enlarged external genitals. Echo-cardiography demonstrated cardiac hypertrophy. Triglyceride level was high with reduced high density lipoproteins (HDL.

  3. Role of cardiopulmonary mechanoreceptors in the postural regulation of renin

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, R.A.; Marco, E.J.; Oliveri, C.; Otero, F.J.; Degrossi, O.; Moledo, L.I.; Julius, S.


    To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

  4. Robust pulse wave velocity estimation by application of system identification to proximal and distal arterial waveforms. (United States)

    Xu, Da; Ryan, Kathy L; Rickards, Caroline A; Zhang, Guanqun; Convertino, Victor A; Mukkamala, Ramakrishna


    Pulse wave velocity (PWV) is a marker of arterial stiffness and may permit continuous, non-invasive, and cuff-less monitoring of blood pressure. Here, robust PWV estimation was sought by application of system identification to proximal and distal arterial waveforms. In this approach, the system that optimally couples the proximal waveform to the distal waveform is identified, and the time delay of this system is then used to calculate PWV. To demonstrate proof-of-concept, a standard identification technique was applied to non-invasive impedance cardiography and peripheral arterial blood pressure waveforms from six humans subjected to progressive reductions in central blood volume induced by lower body negative pressure. This technique estimated diastolic pressure with an overall root-mean-squared-error of 5.2 mmHg. For comparison, the conventional detection method for estimating PWV yielded a corresponding error of 8.3 mmHg.

  5. Creative motivation: creative achievement predicts cardiac autonomic markers of effort during divergent thinking. (United States)

    Silvia, Paul J; Beaty, Roger E; Nusbaum, Emily C; Eddington, Kari M; Kwapil, Thomas R


    Executive approaches to creativity emphasize that generating creative ideas can be hard and requires mental effort. Few studies, however, have examined effort-related physiological activity during creativity tasks. Using motivational intensity theory as a framework, we examined predictors of effort-related cardiac activity during a creative challenge. A sample of 111 adults completed a divergent thinking task. Sympathetic (PEP and RZ) and parasympathetic (RSA and RMSSD) outcomes were assessed using impedance cardiography. As predicted, people with high creative achievement (measured with the Creative Achievement Questionnaire) showed significantly greater increases in sympathetic activity from baseline to task, reflecting higher effort. People with more creative achievements generated ideas that were significantly more creative, and creative performance correlated marginally with PEP and RZ. The results support the view that creative thought can be a mental challenge.

  6. Loeffler endocarditis: magnetic resonance imaging features of pre- and post-operation

    Institute of Scientific and Technical Information of China (English)

    FAN Zhan-ming; LI Yu; YE Hong; YU Jing; GENG Ji; ZHANG Zhao-qi


    @@ Loeffler endocarditis is clinically presented as restrictive cardiomyopathy, which is the least common of the three major categories of cardiomyopathic disorders.1 The endomyocardial fibrosis was considered as its main pathophysiologic changes.2-4 Generally speaking, the characteristics include thickening of the apex and inflow tracts of one or both ventricles, and the papillary muscle and chordae tendineae also can be involved in some cases. The onset of apical thrombosis is very common. In the aspect of showing all of these characteristics, ultrasound cardiography (UCG) has low diagnostic accuracy (not more than 80%);5 CT has been reported rarely; cardiac magnetic resonance (CMR) imaging has dramatic advantages. We present the CMR findings in a typical case of Loeffler endocarditis pre- and post-operation.

  7. Research of echocardiography on coronary artery lesion of Kawasaki disease%川崎病冠状动脉损害的超声研究现状

    Institute of Scientific and Technical Information of China (English)



    Coronary artery lesions caused by Kawasaki disease have main effect to its prognosis.The lesions can be showed as arteriitis,arteriectasis,aneurysm and arterial stenosis stenosis.Ultrasonic cardiography is the first choice to detect the lesions,especially in dilatation and aneurysm formation of the coronary artery.It can definitely show the diameter and the degree of dilatation of the coronary artery.With the development of ultrasonic equipments as well as the applications of new technique,ultrasonic cardiography is playing an important role in Kawasaki disease of early diagnosis,therapeutic effect,prognosis estimation and Iongterm follow -up.%川崎病冠状动脉损害是影响患儿预后的主要因素.冠状动脉损害可表现为动脉炎、动脉扩张、动脉瘤和动脉狭窄等.超声心动图检查是检测川崎病并发冠状动脉损害的首选方法,尤其对冠状动脉扩张和冠状动脉瘤形成的诊断具有特异性,能清晰地显示冠状动脉内径及扩张程度.随着超声设备的升级及相关新技术的应用,超声心动图对川崎病的早期诊断、疗效观察、评估预后和长期随访发挥着愈来愈重要的作用.

  8. Estimating stroke volume from oxygen pulse during exercise. (United States)

    Crisafulli, Antonio; Piras, Francesco; Chiappori, Paolo; Vitelli, Stefano; Caria, Marcello A; Lobina, Andrea; Milia, Raffaele; Tocco, Filippo; Concu, Alberto; Melis, Franco


    This investigation aimed at verifying whether it was possible to reliably assess stroke volume (SV) during exercise from oxygen pulse (OP) and from a model of arterio-venous oxygen difference (a-vO(2)D) estimation. The model was tested in 15 amateur male cyclists performing an exercise test on a cycle-ergometer consisting of a linear increase of workload up to exhaustion. Starting from the analysis of previous published data, we constructed a model of a-vO(2)D estimation (a-vO(2)D(est)) which predicted that the a-vO(2)D at rest was 30% of the total arterial O(2) content (CaO(2)) and that it increased linearly during exercise reaching a value of 80% of CaO(2) at the peak workload (W(max)) of cycle exercise. Then, the SV was calculated by applying the following equation, SV = OP/a-vO(2)D(est), where the OP was assessed as the oxygen uptake/heart rate. Data calculated by our model were compared with those obtained by impedance cardiography. The main result was that the limits of agreement between the SV assessed by impedance cardiography and the SV estimated were between 22.4 and -27.9 ml (+18.8 and -24% in terms of per cent difference between the two SV measures). It was concluded that our model for estimating SV during effort may be reasonably applicable, at least in a healthy population.

  9. Detecting variations of blood volume shift due to heart beat from respiratory inductive plethysmography measurements in man. (United States)

    Fontecave-Jallon, J; Videlier, B; Baconnier, P; Tanguy, S; Calabrese, P; Guméry, P-Y


    The simultaneous study of the cardiac and respiratory activities and their interactions is of great physiological and clinical interest. For this purpose, we want to investigate if respiratory inductive plethysmography (RIP) can be used for cardiac functional exploration. We propose a system, based on RIP technology and time-scale approaches of signal processing, for the extraction of cardiac information. This study focuses on the monitoring of blood volume shift due to heart beat, noted ▵Vtr_c and investigates RIP for the detection of ▵Vtr_c variations by comparison to stroke volume (SV) variations estimated by impedance cardiography (IMP). We proposed a specific respiratory protocol assumed to induce significant variations of the SV. Fifteen healthy volunteers in the seated and supine positions were asked to alternate rest respiration and maneuvers, consisting in blowing into a manometer. A multi-step treatment including a variant of empirical mode decomposition was applied on RIP signals to extract cardiac volume signals and estimate beat-to-beat ▵Vtr_c. These were averaged in quasi-stationary states at rest and during the respiratory maneuvers, and analysed in view of SV estimations from IMP signals simultaneously acquired. Correlation and statistical tests over the data show that RIP can be used to detect variations of the cardiac blood shift in healthy young subjects.

  10. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN


    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

  11. Detecting Aortic Valve Opening and Closing from Distal Body Vibrations

    CERN Document Server

    Wiens, Andrew D; Inan, Omer T


    Objective: Proximal and whole-body vibrations are well studied in seismocardiography and ballistocardiography, yet distal vibrations are still poorly understood. In this paper we develop two methods to measure aortic valve opening (AVO) and closing (AVC) from distal vibrations. Methods: AVO and AVC were detected for each heartbeat with accelerometers on the upper arm (A), wrist (W), and knee (K) of 22 consenting adults following isometric exercise. Exercise-induced changes were recorded with impedance cardiography, and nine-beat ensemble averaging was applied. Our first method, FilterBCG, detects peaks in distal vibrations after filtering with individually-tuned bandpass filters while RidgeBCG uses ridge regression to estimate AVO and AVC without peaks. Pseudocode is provided. Results: In agreement with recent studies, we did not find peaks at AVO and AVC in distal vibrations, and the conventional R-J interval method from the literature also correlated poorly with AVO (r2 = 0.22 A, 0.14 W, 0.12 K). Interestin...

  12. Improvement in Hemodynamic Responses to Metaboreflex Activation after One Year of Training in Spinal Cord Injured Humans

    Directory of Open Access Journals (Sweden)

    Raffaele Milia


    Full Text Available Spinal cord injured (SCI individuals show an altered hemodynamic response to metaboreflex activation due to a reduced capacity to vasoconstrict the venous and arterial vessels below the level of the lesion. Exercise training was found to enhance circulating catecholamines and to improve cardiac preload and venous tone in response to exercise in SCI subjects. Therefore, training would result in enhanced diastolic function and capacity to vasoconstrict circulation. The aim of this study was to test the hypothesis that one year of training improves hemodynamic response to metaboreflex activation in these subjects. Nine SCI individuals were enrolled and underwent a metaboreflex activation test at the beginning of the study (T0 and after one year of training (T1. Hemodynamics were assessed by impedance cardiography and echocardiography at both T0 and T1. Results show that there was an increment in cardiac output response due to metaboreflex activity at T1 as compared to T0 (545.4±683.9 mL·min−1 versus 220.5±745.4 mL·min−1, P<0.05. Moreover, ventricular filling rate response was higher at T1 than at T0. Similarly, end-diastolic volume response was increased after training. We concluded that a period of training can successfully improve hemodynamic response to muscle metaboreflex activation in SCI subjects.

  13. Association of Central Sleep Apnea with Impaired Heart Structure and Cardiovascular Hemodynamics in Patients with Chronic Heart Failure (United States)

    Kazimierczak, Anna; Krzesiński, Paweł; Gielerak, Grzegorz; Uziebło-Życzkowska, Beata; Smurzyński, Paweł; Ryczek, Robert; Cwetsch, Andrzej; Skrobowski, Andrzej


    Background Advanced heart failure (HF) is commonly accompanied by central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR). The aim of this study was to evaluate the relationship between CSA/CSR and other clinical features of HF, with particular emphasis on cardiovascular hemodynamics. Material/Methods In 161 stable HF patients with left ventricular ejection fraction (LVEF) ≤45% (NYHA class I–III; mean LVEF 32.8%) the clinical evaluation included: LVEF; left and right ventricular end-diastolic diameter (LVDd, RVDd); ratio of early transmitral flow velocity to early diastolic septal mitral annulus velocity (E/e’) assessed by echocardiography; stroke index (SI); heart rate (HR); cardiac index (CI); and systemic vascular resistance index (SVRI) assessed by impedance cardiography (ICG). The comparison was performed between 2 subgroups: one with moderate/severe CSA/CSR - CSR_ [+] (n=51), and one with mild or no CSA/CSR – CSR_ [−] (n=110). Results CSR_ [+] patients presented more advanced NYHA class (pCSR_ [+] were identified: NYHA class (OR=3.34 per class, pCSR in HF is associated with NYHA class, atrial fibrillation and more advanced impairment of cardiovascular structure and hemodynamics. Patient functional state remains the main determinant of CSR. PMID:27558771

  14. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.


    Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...... a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0...

  15. Bioimpedância transtorácica comparada à ressonância magnética na avaliação do débito cardíaco Transthoracic impedance compared to magnetic resonance imaging in the assessment of cardiac output

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta Junior


    Full Text Available FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58% do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001, índice cardíaco (r = 0,74; p = 0,0001 e volume sistólico (r = 0,88; p = 0,0001. A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained

  16. Bioimpedância transtorácica comparada à ressonância magnética na avaliação do débito cardíaco Transthoracic impedance compared to magnetic resonance imaging in the assessment of cardiac output

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta Junior


    Full Text Available FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58% do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001, índice cardíaco (r = 0,74; p = 0,0001 e volume sistólico (r = 0,88; p = 0,0001. A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained

  17. Perfectionism and Effort-Related Cardiac Activity: Do Perfectionists Try Harder? (United States)

    Harper, Kelly L; Eddington, Kari M; Silvia, Paul J


    Do perfectionists try harder? Previous research on perfectionism and effort has used self-report items and task performance as indicators of effort. The current study investigated whether individual differences in perfectionism predicted effort-related cardiac activity during a mental effort task. Based on past research that suggests adaptive perfectionism is associated with higher effort, it was hypothesized that self-oriented perfectionism (SOP) would predict increased effort on the task. One hundred and eleven college students completed the Multidimensional Perfectionism Scale (MPS) and a self-paced parity task in which they received a small cash reward (3 cents) for each correct response. Impedance cardiography was used to assess autonomic reactivity, and regression models tested whether SOP and socially prescribed perfectionism (SPP) explained autonomic reactivity. Overall, participants showed both sympathetic (faster pre-ejection period; PEP) and parasympathetic activation (elevated high-frequency heart rate variability; HRV) during the task, reflecting higher effort and engagement. Contrary to predictions, individual differences in perfectionism did not moderate cardiac reactivity. These findings draw attention to the importance of assessing physiological components of effort and motivation directly rather than inferring them from task performance or self-reported effort.


    Directory of Open Access Journals (Sweden)

    Silvana de Araújo SILVA


    Full Text Available The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model and multivariate (Cox regression model analysis. Patients were followed from two to 20 years (mean: 8.2. Their mean age was 44.8 years (20-77. Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01. The predictors for CCC progression in the final regression model were male gender (HR = 2.81, Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02 increased cardiothoracic ratio (HR = 7.87 and time of use of digitalis (HR = 1.41. Patients with multiple predictive factors require stricter follow-up and treatment.

  19. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Robin; Man; Singh; Balkrishna; Man; Singh; Jawahar; Lal; Mehta


    Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.

  20. Role of echocardiography in diagnosis of pulmonary hypertension

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    Srbinovska Kostovska Elizabeta


    Full Text Available Pulmonary hypertension (PH is a progressive process that leads to right ventricular (RV overload, hypertrophy, dilatation and RV failure. In cases with chronic heart failure, this condition is associated with more severe symptoms and worse outcomes.Transthoracic echocardiography can give several parameters which correlate with right heart haemodynamics, and should be performed in a case of suspected PH. Several parameters are important for estimation of the RV function, which can be reason for poor outcome: right atrial and ventricular dimensions and volumes, functional area changes, tricuspid annular plane systolic excursion (TAPSE, myocardial performance index, infe- rior vena cava size and collapsibility, S velocity estimated by Tissue Doppler Imaging, and additional information obtained from the advance echocardiograpic techniques, like strain, strain rate, three-dimensional echocardiography. Estimation of PH based on Doppler echo- cardiography measurements is not suitable for screening of mild, asymptomatic PH. Echocardiography can be recommended as a screening tool for specific diseases, follow up PH, and assessment when right heart catheterization is indicated.

  1. Is blunted cardiovascular reactivity in depression mood-state dependent? A comparison of major depressive disorder remitted depression and healthy controls. (United States)

    Salomon, Kristen; Bylsma, Lauren M; White, Kristi E; Panaite, Vanessa; Rottenberg, Jonathan


    Prior work has repeatedly demonstrated that people who have current major depression exhibit blunted cardiovascular reactivity to acute stressors (e.g., Salomon et al., 2009). A key question regards the psychobiological basis for these deficits, including whether such deficits are depressed mood-state dependent or whether these effects are trait-like and are observed outside of depression episodes in vulnerable individuals. To examine this issue, we assessed cardiovascular reactivity to a speech stressor task and a forehead cold pressor in 50 individuals with current major depressive disorder (MDD), 25 with remitted major depression (RMD), and 45 healthy controls. Heart rate (HR), blood pressure and impedance cardiography were assessed and analyses controlled for BMI and sex. Significant group effects were found for SBP, HR, and PEP for the speech preparation period and HR, CO, and PEP during the speech. For each of these parameters, only the MDD group exhibited attenuated reactivity as well as impaired SBP recovery. Reactivity and recovery in the RMD group more closely resembled the healthy controls. Speeches given by the MDD group were rated as less persuasive than the RMD or healthy controls' speeches. No significant differences were found for the cold pressor. Blunted cardiovascular reactivity and impaired recovery in current major depression may be mood-state dependent phenomena and may be more reflective of motivational deficits than deficits in the physiological integrity of the cardiovascular system.

  2. Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure. (United States)

    Borghi-Silva, Audrey; Carrascosa, Cláudia; Oliveira, Cristino Carneiro; Barroco, Adriano C; Berton, Danilo C; Vilaça, Debora; Lira-Filho, Edgar B; Ribeiro, Dirceu; Nery, Luiz Eduardo; Neder, J Alberto


    Blood flow requirements of the respiratory muscles (RM) increase markedly during exercise in chronic heart failure (CHF). We reasoned that if the RM could subtract a fraction of the limited cardiac output (QT) from the peripheral muscles, RM unloading would improve locomotor muscle perfusion. Nine patients with CHF (left ventricle ejection fraction = 26 +/- 7%) undertook constant-work rate tests (70-80% peak) receiving proportional assisted ventilation (PAV) or sham ventilation. Relative changes (Delta%) in deoxy-hemoglobyn, oxi-Hb ([O2Hb]), tissue oxygenation index, and total Hb ([HbTOT], an index of local blood volume) in the vastus lateralis were measured by near infrared spectroscopy. In addition, QT was monitored by impedance cardiography and arterial O2 saturation by pulse oximetry (SpO2). There were significant improvements in exercise tolerance (Tlim) with PAV. Blood lactate, leg effort/Tlim and dyspnea/Tlim were lower with PAV compared with sham ventilation (P 0.05). Unloaded breathing, however, was related to enhanced leg muscle oxygenation and local blood volume compared with sham, i.e., higher Delta[O2Hb]% and Delta[HbTOT]%, respectively (P < 0.05). We conclude that RM unloading had beneficial effects on the oxygenation status and blood volume of the exercising muscles at similar systemic O2 delivery in patients with advanced CHF. These data suggest that blood flow was redistributed from respiratory to locomotor muscles during unloaded breathing.

  3. Obesity Interacts with Cerebral Hypoperfusion to Exacerbate Cognitive Impairment in Older Adults with Heart Failure

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    Michael L. Alosco


    Full Text Available Background: Cerebral hypoperfusion accompanies heart failure (HF and is associated with reduced cognitive performance. Obesity is prevalent in persons with HF and is also a likely contributor to cognitive function, as it has been independently linked to cognitive impairment in healthy individuals. The current study examined the association between obesity and cognitive performance among older adults with HF and whether obesity interacts with cerebral hypoperfusion to exacerbate cognitive impairment. Methods: Patients with HF (n = 99, 67.46 ± 11.36 years of age completed neuropsychological testing and impedance cardiography. Cerebral blood flow velocity (CBF-V measured by transcranial Doppler sonography quantified cerebral perfusion and body mass index (BMI operationalized obesity. Results: A hierarchical regression analysis showed that lower CBF-V was associated with reduced performance on tests of attention/executive function and memory. Elevated BMI was independently associated with reduced attention/executive function and language test performance. Notably, a significant interaction between CBF-V and BMI indicated that a combination of hypoperfusion and high BMI has an especially adverse influence on attention/executive function in HF patients. Conclusions: The current findings suggest that cerebral hypoperfusion and obesity interact to impair cognitive performance in persons with HF. These results may have important clinical implications, as HF patients who are at high risk for cerebral hypoperfusion may benefit from weight reduction.

  4. Improved pulse transit time estimation by system identification analysis of proximal and distal arterial waveforms. (United States)

    Xu, Da; Ryan, Kathy L; Rickards, Caroline A; Zhang, Guanqun; Convertino, Victor A; Mukkamala, Ramakrishna


    We investigated the system identification approach for potentially improved estimation of pulse transit time (PTT), a popular arterial stiffness marker. In this approach, proximal and distal arterial waveforms are measured and respectively regarded as the input and output of a system. Next, the system impulse response is identified from all samples of the measured input and output. Finally, the time delay of the impulse response is detected as the PTT estimate. Unlike conventional foot-to-foot detection techniques, this approach is designed to provide an artifact robust estimate of the true PTT in the absence of wave reflection. The approach is also applicable to arbitrary types of arterial waveforms. We specifically applied a parametric system identification technique to noninvasive impedance cardiography (ICG) and peripheral arterial blood pressure waveforms from 15 humans subjected to lower-body negative pressure. We assessed the technique through the correlation coefficient (r) between its 1/PTT estimates and measured diastolic pressure (DP) per subject and the root mean squared error (RMSE) of the DP predicted from these estimates and measured DP. The technique achieved average r and RMSE values of 0.81 ± 0.16 and 4.3 ± 1.3 mmHg. For comparison, the corresponding values were 0.59 ± 0.37 (P system identification approach can indeed improve PTT estimation.

  5. Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

    Directory of Open Access Journals (Sweden)

    Alexey N. Kuznetsov


    Full Text Available Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES and robotic tilt-table training (ROBO against tilt-table training alone (control. A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age years, days after stroke were assigned to 30 days of ROBO-FES (, ROBO (, or control ( in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped % during robot training. In 52% of controls mean arterial pressure decreased by %. ROBO-FES increased leg strength by points, ROBO by more than control (, . CBFV increased in both robotic groups more than in controls (. Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

  6. Association of Central Sleep Apnea with Impaired Heart Structure and Cardiovascular Hemodynamics in Patients with Chronic Heart Failure. (United States)

    Kazimierczak, Anna; Krzesiński, Paweł; Gielerak, Grzegorz; Uziębło-Życzkowska, Beata; Smurzyński, Paweł; Ryczek, Robert; Cwetsch, Andrzej; Skrobowski, Andrzej


    BACKGROUND Advanced heart failure (HF) is commonly accompanied by central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR). The aim of this study was to evaluate the relationship between CSA/CSR and other clinical features of HF, with particular emphasis on cardiovascular hemodynamics. MATERIAL AND METHODS In 161 stable HF patients with left ventricular ejection fraction (LVEF) ≤45% (NYHA class I-III; mean LVEF 32.8%) the clinical evaluation included: LVEF; left and right ventricular end-diastolic diameter (LVDd, RVDd); ratio of early transmitral flow velocity to early diastolic septal mitral annulus velocity (E/e') assessed by echocardiography; stroke index (SI); heart rate (HR); cardiac index (CI); and systemic vascular resistance index (SVRI) assessed by impedance cardiography (ICG). The comparison was performed between 2 subgroups: one with moderate/severe CSA/CSR - CSR_ [+] (n=51), and one with mild or no CSA/CSR - CSR_ [-] (n=110). RESULTS CSR_ [+] patients presented more advanced NYHA class (pCSR_ [+] were identified: NYHA class (OR=3.34 per class, pCSR in HF is associated with NYHA class, atrial fibrillation and more advanced impairment of cardiovascular structure and hemodynamics. Patient functional state remains the main determinant of CSR.

  7. Computational modelling of blood-flow-induced changes in blood electrical conductivity and its contribution to the impedance cardiogram. (United States)

    Trakic, A; Akhand, M; Wang, H; Mason, D; Liu, F; Wilson, S; Crozier, S


    Studies have shown that blood-flow-induced change in electrical conductivity is of equal importance in assessment of the impedance cardiogram (ICG) as are volumetric changes attributed to the motion of heart, lungs and blood vessels. To better understand the sole effect of time-varying blood conductivity on the spatiotemporal distribution of trans-thoracic electric fields (i.e. ICG), this paper presents a segmented high-resolution (1 mm(3)) thoracic cardiovascular system, in which the time-varying pressures, flows and electrical conductivities of blood in different vessels are evaluated using a set of coupled nonlinear differential equations, red blood cell orientation and cardiac cycle functions. Electric field and voltage simulations are performed using two and four electrode configurations delivering a small alternating electric current to an anatomically realistic and electrically accurate model of modelled human torso. The simulations provide a three-dimensional electric field distribution and show that the time-varying blood conductivity alters the voltage potential difference between the electrodes by a maximum of 0.28% for a cardiac output of about 5 L min(-1). As part of a larger study, it is hoped that this initial model will be useful in providing improved insights into blood-flow-related spatiotemporal electric field variations and assist in the optimal placement of electrodes in impedance cardiography experiments.

  8. Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)--results of a preliminary investigation. (United States)

    Sack, Martin; Lempa, Wolfgang; Steinmetz, Adrian; Lamprecht, Friedhelm; Hofmann, Arne


    EMDR combines stimuli that evoke divided attention--e.g. eye movements--with exposure to traumatic memories. Our objective was to investigate psycho-physiological correlates of EMDR during treatment sessions. A total of 55 treatment sessions from 10 patients with PTSD was monitored applying impedance cardiography. Onset of every stimulation/exposure period (n=811) was marked and effects within and across stimulation sets on heart rate (HR), heart rate variability (HRV), pre-ejection period (PEP) and respiration rate were examined. At stimulation onsets a sharp increase of HRV and a significant decrease of HR was noticed indicating de-arousal. During ongoing stimulation, PEP and HRV decreased significantly while respiration rate significantly increased, indicating stress-related arousal. However, across entire sessions a significant decrease of psycho-physiological activity was noticed, evidenced by progressively decreasing HR and increasing HRV. These findings suggest that EMDR is associated with patterns of autonomic activity associated with substantial psycho-physiological de-arousal over time.

  9. Relationship between changes in pulmonary V̇O₂ kinetics and autonomic regulation of blood flow. (United States)

    McNarry, M A; Kingsley, M I C; Lewis, M J


    Various regulatory mechanisms of pulmonary oxygen uptake (V̇O2) kinetics have been postulated. The purpose of this study was to investigate the relationship between vagal withdrawal, measured using RMSSDRR, the root mean square of successive differences in cardiac interval (RR) kinetics, a mediator of oxygen delivery, and V̇O2 kinetics. Forty-nine healthy adults (23 ± 3 years; 72 ± 13 kg; 1.80 ± 0.08 m) performed multiple repeat transitions to moderate- and heavy-intensity exercise. Electrocardiography, impedance cardiography, and pulmonary gas exchange parameters were measured throughout; time domain measures of heart rate variability were subsequently derived. The parameters describing the dynamic response of V̇O2, cardiac output (Q) and RMSSDRR were determined using a mono-exponential model. During heavy-intensity exercise, the phase II τ of V̇O2 was significantly correlated with the τ of RR (r = 0.36, P kinetics and those of Q, RR, or RMSSDRR during moderate exercise. Vagal withdrawal kinetics support the concept of a centrally mediated oxygen delivery limitation partly regulating V̇O2 kinetics during heavy-, but not moderate-, intensity exercise.

  10. Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus. (United States)

    Alhogbani, Tariq


    The novel Middle east respiratory syndrome coronavirus (MeRS-CoV) has been identified as a cause of pneumonia; however, it has not been reported as a cause of acute myocarditis. A 60-year-old man presented with pneumonia and congestive heart failure. On the first day of admission, he was found to have an elevated troponin-l level and severe global left ventricular systolic dysfunction on echo-cardiography. The serum creatinine level was found mildly elevated. Chest radiography revealed in the lower lung fields accentuated bronchovascular lung markings and multiple small patchy opacities. Laboratory tests were negative for viruses known to cause myocarditis. Sputum sample was positive for MeRS-CoV. Cardiovascular magnetic resonance revealed evidence of acute myocarditis. the patient had all criteria specified by the international Consensus Group on CMR in Myocarditis that make a clinical suspicion for acute myocarditis. this was the first case that demonstrated that MeRS-CoV may cause acute myocarditis and acute-onset heart failure.

  11. [Evaluation of orthostatic regulation by saddle support test using thoracic impedance]. (United States)

    Gugova, F K; Lapin, V V


    We investigated 21 healthy volunteers (10 males and 11 females, mean age 23 +/- 4 years). All the subjects have undergone two 20 min head-up tilt tests using tilt table "TRI W.G. inc." (USA): the first with footplate support and the second with bicycle saddle. Thoracic electrical impedance was measured using impedance cardiography according to Kubicek et al. The protocols included an initial period of 20 min of supine rest while baseline thoracic impedance, blood pressure and heart rate were recorded and then followed by a tilt to 65 degrees. Changes of impedance were measured at min 1, 2, 3, 5, 7, 10, 15, 20 after the procedure. Women had higher values of thoracic impedance both at rest and during the tilt test than men. The value of impedance of the chest negatively correlated with the body mass index. We suppose that an increase of impedance more than 15% may be related with pathological venous pooling. Thoracic impedance may be used to monitor changes of thoracic fluid volumes with posture and possibly to assess orthostatic regulation. The contribution of leg muscles in orthostatic regulation does not reflect values of thoracic impedance.

  12. Cardiovascular responses to the ingestion of sugary drinks using a randomised cross-over study design: Does glucose attenuate the blood pressure-elevating effect of fructose? (United States)

    Grasser, Erik K; Dulloo, Abdul; Montani, Jean-Pierre


    Overconsumption of sugar-sweetened beverages has been implicated in the pathogenesis of CVD. The objective of the present study was to elucidate acute haemodynamic and microcirculatory responses to the ingestion of sugary drinks made from sucrose, glucose or fructose at concentrations similar to those often found in commercial soft drinks. In a randomised cross-over study design, twelve young healthy human subjects (seven men) ingested 500 ml tap water in which was dissolved 60 g of either sucrose, glucose or fructose, or an amount of fructose equivalent to that present in sucrose (i.e. 30 g fructose). Continuous cardiovascular monitoring was performed for 30 min before and at 60 min after ingestion of sugary drinks, and measurements included beat-to-beat blood pressure (BP) and impedance cardiography. Additionally, microvascular endothelial function testing was performed after iontophoresis of acetylcholine and sodium nitroprusside using laser Doppler flowmetry. Ingestion of fructose (60 or 30 g) increased diastolic and mean BP to a greater extent than the ingestion of 60 g of either glucose or sucrose (Psugary drinks. In conclusion, ingestion of fructose, but not sucrose, increases BP in healthy human subjects. Although sucrose comprises glucose and fructose, its changes in TPR and CO are more related to glucose than to fructose.

  13. A wideband high common mode rejection ratio amplifier and phase-locked loop demodulator for multifrequency impedance measurement. (United States)

    Goovaerts, H G; Faes, T J; Raaijmakers, E; Heethaar, R M


    Design considerations and implementation of a multifrequency measuring channel for application in the field of bio-impedance measurement are discussed in this paper. The input amplifier has a differential configuration which is electrically isolated from the remaining circuits. Transformer coupling provides improved common mode rejection when compared to non-isolated input stages. The frequency characteristic of the section between input and demodulator is flat within +/- 0.1 dB between 4 kHz and 1024 kHz. The synchronous demodulator is based on a wideband switched video amplifier. In contrast to commonly used lock--in techniques, the carrier for demodulation is recovered from the input signal by means of a phase-locked loop. This method ensures zero phase shift with respect to the input signal and improves the accuracy of measurement. The system has been developed primarily for thoracic impedance cardiography (TIC) but has also successfully been applied in the field of total body bio-impedance analysis (BIA). At present an electrical impedance tomograph is under development based on the instrumentation described. Results regarding the measurement range and accuracy are given and some recordings of patient data are shown.

  14. Comparison of Sympathomimetics in the Correction of Arterial Hypotension during Combined Anesthesia

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    D. B. Borisov


    Full Text Available Objective: to make a comparative assessment of hemodynamic parameters when correcting combined anesthesia-induced arterial hypotension with dopamine, adrenaline, mesatone, or noradrenaline. Subjects and methods. A prospective study enrolled patients who had undergone prosthetic hip replacement under combined lumbar epidural (ropivacaine/general (sevoflurane anesthesia. Intravenous sympathomimetic infusion was initiated when the mean blood pressure decreased below 55 Hg mm. Cardiac index (CI and systemic vascular resistance index (SVRI were calculated by impedance cardiography. Fifty-six subjects (14 in each group were selected for analysis. Results. During the study, CI remained in the normal range for all sympathomimetics. When adrenaline was administered, there was an obvious tendency to maintain blood pressure due to heart rate (HR with preserved low SVRI. The use of mesatone caused a considerable reduction in HR. No statistically significant differences were found between the dopamine and noradrenaline groups in any of the study stages. The start of infusion of these agents was attended by SVRI normalization and HR maintenance within 60—70 beats per minute. Conclusion. The infusion of dopamine, adrenaline, mesatone, or noradrenaline to correct arterial hypotension resulting from combined epidural block/general anesthesia with sevoflurane ensures maintenance of CI within the normal range. That of noradrenaline and dopamine was ascertained to have a more balanced impact on HR and systemic vascular resistance. Key words: combined anesthesia, epidural block, hemodynamics, sympathomimetics, adrenaline, dopamine, mesatone, noradrenaline.

  15. Do depressive symptoms "blunt" effort? An analysis of cardiac engagement and withdrawal for an increasingly difficult task. (United States)

    Silvia, Paul J; Mironovová, Zuzana; McHone, Ashley N; Sperry, Sarah H; Harper, Kelly L; Kwapil, Thomas R; Eddington, Kari M


    Research on depression and effort has suggested "depressive blunting"-lower cardiovascular reactivity in response to challenges and stressors. Many studies, however, find null effects or higher reactivity. The present research draws upon motivational intensity theory, a broad model of effort that predicts cases in which depressive symptoms should increase or decrease effort. Because depressive symptoms can influence task-difficulty appraisals-people see tasks as subjectively harder-people high in depressive symptoms should engage higher effort at objectively easier levels of difficulty but also quit sooner. A sample of adults completed a mental effort challenge with four levels of difficulty, from very easy to difficult-but-feasible. Depressive symptoms were assessed with the CESD and DASS; effort-related cardiac activity was assessed via markers of contractility (e.g., the cardiac pre-ejection period [PEP]) obtained with impedance cardiography. The findings supported the theory's predictions. When the task was relatively easier, people high in depressive symptoms showed higher contractility (shorter PEP), consistent with greater effort. When the task was relatively harder, people high in depressive symptoms showed diminished contractility, consistent with quitting. The results suggest that past research has been observing a small part of a larger trajectory of trying and quitting, and they illustrate the value of a theoretically grounded analysis of depressive symptoms and effort-related cardiac activity.

  16. Prenatal stress and balance of the child's cardiac autonomic nervous system at age 5-6 years.

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    Aimée E van Dijk

    Full Text Available OBJECTIVE: Autonomic nervous system (ANS misbalance is a potential causal factor in the development of cardiovascular disease. The ANS may be programmed during pregnancy due to various maternal factors. Our aim is to study maternal prenatal psychosocial stress as a potential disruptor of cardiac ANS balance in the child. METHODS: Mothers from a prospective birth cohort (ABCD study filled out a questionnaire at gestational week 16 [IQR 12-20], that included validated instruments for state anxiety, depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain. A cumulative stress score was also calculated (based on 80(th percentiles. Indicators of cardiac ANS in the offspring at age 5-6 years are: pre-ejection period (PEP, heart rate (HR, respiratory sinus arrhythmia (RSA and cardiac autonomic balance (CAB, measured with electrocardiography and impedance cardiography in resting supine and sitting positions. RESULTS: 2,624 mother-child pairs, only single births, were available for analysis. The stress scales were not significantly associated with HR, PEP, RSA and CAB (p≥0.17. Accumulation of maternal stress was also not associated with HR, PEP, RSA and CAB (p≥0.07. CONCLUSION: Results did not support the hypothesis that prenatal maternal psychosocial stress deregulates cardiac ANS balance in the offspring, at least in rest, and at the age of five-six years.

  17. Simulation of 'pathologic' changes in ICG waveforms resulting from superposition of the 'preejection' and ejection waves induced by left ventricular contraction (United States)

    Ermishkin, V. V.; Kolesnikov, V. A.; Lukoshkova, E. V.; Sonina, R. S.


    The impedance cardiography (ICG) is widely used for beat-to-beat noninvasive evaluation of the left ventricular stroke volume and contractility. It implies the correct determination of the ejection start and end points and the amplitudes of certain peaks in the differentiated impedance cardiogram. An accurate identification of ejection onset by ICG is often problematic, especially in the cardiologic patients, due to peculiar waveforms. Using a simple theoretical model, we tested the hypothesis that two major processes are responsible for the formation of impedance systolic wave: (1) the changes in the heart geometry and surrounding vessels produced by ventricular contraction, which occur during the isovolumic phase and precede ejection, and (2) expansion of aorta and adjacent arteries during the ejection phase. The former process initiates the preejection wave WpE and the latter triggers the ejection wave WEj. The model predicts a potential mechanism of generating the abnormal shapes of dZ/dt due to the presence of preejection waves and explains the related errors in ICG time and amplitude parameters. An appropriate decomposition method is a promising way to avoid the masking effects of these waves and a further step to correct determination of the onset of ejection and the corresponding peak amplitudes from 'pathologically shaped' ICG signals.

  18. Cardiac effects of the c.1583 C→G LMNA mutation in two families with Emery-Dreifuss muscular dystrophy. (United States)

    Zhang, Li; Shen, Hongrui; Zhao, Zhe; Bing, Qi; Hu, Jing


    The present study aimed to examine and analyze cardiac involvement in two Emery‑Dreifuss muscular dystrophy (EDMD) pedigrees caused by the c.1583 C→G mutation of the lamin A/C gene (LMNA). The clinical and genetic characteristics of members of two families with EDMD were evaluated by performing neurological examinations, skeletal muscle biopsies, cardiac evaluations, including electrocardiography, 24 h Holter, ultrasound cardiography and 99TcM‑MIBI‑gated myocardiac perfusion imaging, and genomic DNA sequencing. Family history investigations revealed an autosomal dominant transmission pattern of the disease in Family 1 and a sporadic case in Family 2. The three affected patients exhibited typical clinical features of EDMD, including joint contractures, muscle weakness and cardiac involvement. Muscle histopathological investigation revealed dystrophic features. In addition, each affected individual exhibited either cardiac arrhythmia, which was evident as sinus tachycardia, atrial flutter or complete atrioventricular inhibition. Cardiac imaging revealed dilated cardiomyopathy in two of the individuals, one of whom was presented with heart failure. The second patient presented with no significant abnormalities in cardiac structure or function. The three affected individuals exhibited a heterozygous missense mutation in the LMNA gene (c.1583 C→G), which caused a T528R amino acid change in the LMNA protein. In conclusion, the present study identified three patients with EDMD, exhibiting the same dominant LMNA mutation and presenting with a spectrum of severe cardiac abnormalities, including cardiac conduction system defects, cardiomyopathy and heart failure. As LMNA mutations have been associated with at least six clinical disorders, including EDMD, the results of the present study provide additional mutational and functional data, which may assist in further establishing LMNA mutational variation and disease pathogenesis.

  19. Cerebro- and cardiovascular responses to energy drink in young adults: Is there a gender effect?

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    Cathriona R Monnard


    Full Text Available Background and Purpose: Energy drinks (EDs are suspected to induce potential adverse cardiovascular effects and have recently been shown to reduce cerebral blood flood velocity (CBFV in young, healthy subjects. Gender differences in CBFV in response to EDs have not previously been investigated, despite the fact that women are more prone to cardiovascular disturbances such as neurocardiogenic syncope than men. Therefore, the aim of this study was to explore gender differences in cerebrovascular and cardiovascular responses to EDs.Methods: We included 45 subjects in a retrospective analysis of pooled data from two previous randomized trials carried out in our laboratory with similar protocols. Beat-to-beat blood pressure, impedance cardiography, transcranial Doppler, and end-tidal carbon dioxide (etCO2 measurements were made for at least 20 min baseline and for 80 min following the ingestion of 355 mL of a sugar-sweetened ED. Gender and time differences in cerebrovascular and cardiovascular parameters were investigated.Results: CBFV was significantly reduced in response to ED, with the greatest reduction observed in women compared with men (-12.3 ± 0.8 vs. -9.7 ± 0.8 %, P < 0.05. Analysis of variance indicated significant time (P < 0.01 and gender x time (P < 0.01 effects. The percentage change in CBFV in response to ED was independent of body weight and etCO2. No significant gender difference in major cardiovascular parameters in response to ED was observed.Conclusions: ED ingestion reduced CBFV over time, with a greater reduction observed in women compared with men. Our results have potential implications for women ED consumers, as well as high-risk individuals.

  20. Do mathematical model studies settle the controversy on the origin of cardiac synchronous trans-thoracic electrical impedance variations? A systematic review. (United States)

    de Sitter, A; Verdaasdonk, R M; Faes, T J C


    Impedance cardiography (ICG) is a method to evaluate cardiac-stroke volume and cardiac-output by measuring the cardiac-synchronous changes in the dynamic trans-thoracic electrical impedance (ΔZ). Clinical evaluations on the accuracy of ICG showed varying results. Consequently, the classic assumption in ICG-the aorta as a main source of ΔZ-is questioned and subsequently investigated in simulation studies using mathematical models of the electrical resistivity of the human body. The aim is to review the consensus in mathematical modelling studies that investigate the origin of the ΔZ as measured in ICG. In a systematic literature search, studies were identified and surveyed with reference to characteristics, such as included organs and their resistivity and geometries, electrode positions and calculation of ΔZ, to review the consensus between mathematical modelling studies that investigate the origin of the ΔZ as measured in ICG. Thirteen papers showed considerable variation in the model's characteristics with varying or contradicting outcomes for the ΔZ 's origin. For instance, 11 studies excluded perfused muscle tissue, implying implicitly their insignificance, while 3 other studies included muscle tissue and indicated it as the most important origin of ΔZ. In conclusion, the reviewed papers show a lack of consensus with respect to both the modelled characteristics as well as the model outcomes and, as a result, these studies failed to settle the controversy on ΔZ 's origin. Recommendations have been added to improve future mathematical model studies.

  1. Effect of fermented milk product containing lactotripeptides and plant sterol esters on haemodynamics in subjects with the metabolic syndrome--a randomised, double-blind, placebo-controlled study. (United States)

    Hautaniemi, Elina J; Tikkakoski, Antti J; Tahvanainen, Anna; Nordhausen, Klaus; Kähönen, Mika; Mattsson, Tiina; Luhtala, Satu; Turpeinen, Anu M; Niemelä, Onni; Vapaatalo, Heikki; Korpela, Riitta; Pörsti, Ilkka H


    We investigated the effects of fermented milk product containing isoleucine-proline-proline, valine-proline-proline and plant sterol esters (Pse) on plasma lipids, blood pressure (BP) and its determinants systemic vascular resistance and cardiac output. In a randomised, double-blind, placebo-controlled study, 104 subjects with the metabolic syndrome (MetS) were allocated to three groups in order to receive fermented milk product containing (1) 5 mg/d lactotripeptides (LTP) and 2 g/d plant sterols; (2) 25 mg/d LTP and 2 g/d plant sterols; (3) placebo for 12 weeks. Plasma lipids and home BP were monitored. Haemodynamics were examined in a laboratory using radial pulse wave analysis and whole-body impedance cardiography in the supine position and during orthostatic challenge. There were no differences between the effects of the two treatments and placebo on the measurements of BP at home or on BP, systemic vascular resistance index and cardiac index in the laboratory, neither in the supine nor in the upright position. The changes in plasma LDL-cholesterol concentration were - 0.1 (95% CI - 0.3, 0.1 and - 0.3, 0.0) mmol/l in the 5 and 25 mg/d LTP groups, respectively, and +0.1 (95% CI - 0.1, 0.3) mmol/l during placebo (P= 0.024). Both at baseline and at week 12, the increase in systemic vascular resistance during head-up tilt was lower in the 25 mg/d LTP group than in the 5 mg/d LTP group (Ppersistent differences in cardiovascular regulation between these groups. In subjects with the MetS, intake of LTP and Pse in fermented milk product showed a lipid-lowering effect of borderline significance, while no antihypertensive effect was observed at home or in the laboratory.

  2. Establishment of a chronic left ventricular aneurysm model in rabbit

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    Cang-Song XIAO; Chang-Qing GAO; Li-Bing LI; Yao WANG; Tao ZHAO; Wei-Hua YE; Chong-Lei REN; Zhi-Yong LIU; Yang WU


    Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.

  3. Can echocardiographic findings predict falls in older persons?

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    Nathalie van der Velde

    Full Text Available BACKGROUND: The European and American guidelines state the need for echocardiography in patients with syncope. 50% of older adults with syncope present with a fall. Nonetheless, up to now no data have been published addressing echocardiographic abnormalities in older fallers. METHOD AND FINDINGS: In order to determine the association between echocardiographic abnormalities and falls in older adults, we performed a prospective cohort study, in which 215 new consecutive referrals (age 77.4, SD 6.0 of a geriatric outpatient clinic of a Dutch university hospital were included. During the previous year, 139 had experienced a fall. At baseline, all patients underwent routine two-dimensional and Doppler echocardiography. Falls were recorded during a three-month follow-up. Multivariate adjustment for confounders was performed with a Cox proportional hazards model. 55 patients (26% fell at least once during follow-up. The adjusted hazard ratio of a fall during follow-up was 1.35 (95% CI, 1.08-1.71 for pulmonary hypertension, 1.66 (95% CI, 1.01 to 2.89 for mitral regurgitation, 2.41 (95% CI, 1.32 to 4.37 for tricuspid regurgitation and 1.76 (95% CI, 1.03 to 3.01 for pulmonary regurgitation. For aortic regurgitation the risk of a fall was also increased, but non-significantly (hazard ratio, 1.57 [95% CI, 0.85 to 2.92]. Trend analysis of the severity of the different regurgitations showed a significant relationship for mitral, tricuspid and pulmonary valve regurgitation and pulmonary hypertension. CONCLUSIONS: Echo (Doppler cardiography can be useful in order to identify risk indicators for falling. Presence of pulmonary hypertension or regurgitation of mitral, tricuspid or pulmonary valves was associated with a higher fall risk. Our study indicates that the diagnostic work-up for falls in older adults might be improved by adding an echo (Doppler cardiogram in selected groups.

  4. 16. Optimal guidance of percutaneous device closure of PDA by transthoracic echocardiography

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    M. Alobaidan


    Full Text Available Patent ductus arteriosus (PDA is common congenital cardiac lesion and the most accepted way of management is transcatheter occlusion by device which is usually done under fluoroscopy guidance. Transoesophageal echo cardiography and transaortic imaging were used in adult to guide the procedure which is with certain applications in pediatric age group transthoracic echocardiography (TTE in pediatric population provides excellent images for PDA and may replace the use of fluoroscopy to guide PDA closure at least in special situations. To highlight the feasibility of device closure under guidance of TTE to be applied in sick patients who are not suitable for transfer to cardiac catheter laboratory or those with contraindication to contrast and or radiation application. 18 patients from July 2013 to May 2015 underwent TTE guidance device closure of PDA, 1 patient was excluded after device embolization which necessitate retrieval under fluoroscopy (fluoro.. Conscious sedation was used in 17 patients except 1 who was sick and already ventilated in ICU, there were 11 female and 7 male, antegrade approach was used in 10 patients with partial fluoro and retrograde approach in 8 patients without fluoro. Median age is 7 months, median weight is 8 kg (3.2–11 kg, 2 patients with renal impairment, 2 with Leukemia, median procedure time is 35 min, median fluoro. is 2.2 min, PDA size were small in 13 patients and moderate in 5, immediate closure is achieved in all. The devices were ADOI, ADOS, ADOII, Occlutech, and AVP2. Device embolization in 1 with successful retrieval and second device was used with complete closure percutaneous PDA closure under TTE guidance is feasible, safe and recommended in selected patients with certain situation.

  5. A Thorax Simulator for Complex Dynamic Bioimpedance Measurements With Textile Electrodes. (United States)

    Ulbrich, Mark; Muhlsteff, Jens; Teichmann, Daniel; Leonhardt, Steffen; Walter, Marian


    Bioimpedance measurements on the human thorax are suitable for assessment of body composition or hemodynamic parameters, such as stroke volume; they are non-invasive, easy in application and inexpensive. When targeting personal healthcare scenarios, the technology can be integrated into textiles to increase ease, comfort and coverage of measurements. Bioimpedance is generally measured using two electrodes injecting low alternating currents (0.5-10 mA) and two additional electrodes to measure the corresponding voltage drop. The impedance is measured either spectroscopically (bioimpedance spectroscopy, BIS) between 5 kHz and 1 MHz or continuously at a fixed frequency around 100 kHz (impedance cardiography, ICG). A thorax simulator is being developed for testing and calibration of bioimpedance devices and other new developments. For the first time, it is possible to mimic the complete time-variant properties of the thorax during an impedance measurement. This includes the dynamic real part and dynamic imaginary part of the impedance with a peak-to-peak value of 0.2 Ω and an adjustable base impedance (24.6 Ω ≥ Z0 ≥ 51.6 Ω). Another novelty is adjustable complex electrode-skin contact impedances for up to 8 electrodes to evaluate bioimpedance devices in combination with textile electrodes. In addition, an electrocardiographic signal is provided for cardiographic measurements which is used in ICG devices. This provides the possibility to generate physiologic impedance changes, and in combination with an ECG, all parameters of interest such as stroke volume (SV), pre-ejection period (PEP) or extracellular resistance (Re) can be simulated. The speed of all dynamic signals can be altered. The simulator was successfully tested with commercially available BIS and ICG devices and the preset signals are measured with high correlation (r = 0.996).

  6. Cardiac output monitoring

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    Mathews Lailu


    Full Text Available Minimally invasive and non-invasive methods of estimation of cardiac output (CO were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC and direct Fick method used for the measurement of stroke volume (SV. The important minimally invasive techniques available are: oesophageal Doppler monitoring (ODM, the derivative Fick method (using partial carbon dioxide (CO 2 breathing, transpulmonary thermodilution, lithium indicator dilution, pulse contour and pulse power analysis. Impedance cardiography is probably the only non-invasive technique in true sense. It provides information about haemodynamic status without the risk, cost and skill associated with the other invasive or minimally invasive techniques. It is important to understand what is really being measured and what assumptions and calculations have been incorporated with respect to a monitoring device. Understanding the basic principles of the above techniques as well as their advantages and limitations may be useful. In addition, the clinical validation of new techniques is necessary to convince that these new tools provide reliable measurements. In this review the physics behind the working of ODM, partial CO 2 breathing, transpulmonary thermodilution and lithium dilution techniques are dealt with. The physical and the physiological aspects underlying the pulse contour and pulse power analyses, various pulse contour techniques, their development, advantages and limitations are also covered. The principle of thoracic bioimpedance along with computation of CO from changes in thoracic impedance is explained. The purpose of the review is to help us minimize the dogmatic nature of practice favouring one technique or the other.

  7. Myocardial scintigraphy - 25 years after start

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    Hoer, G.


    The development of myocardial scintigraphy (MS) reflects the clinical success of a representative procedure in nuclear medicine. Radiopharmaceuticals for visualizing vital and damaged myocardium and techniques (planar-qualitative, planar-quantitative, SPECT-qualitative-quantitative with comparative sensitivities) are briefly reviewed with the main focus on their clinical application in coronary (CHD) and noncoronary heart disease, where recent literature from the United States and Europe is considered. The limited value of MS for screening of CHD is outlined and its present and future role in detecting asymptomatic (silent) ischemia/infarction and asymptomatic patients at professional risk is stressed. The present state of MS in coronary heart disease is discussed for single and multivessel disease, previous infarction, and risk stratification (myocardial washout, pulmonary uptake, ischemic dilation, absent heart sign), reflecting the importance of the procedure in exercise-induced ischemia as well as in ischemia at rest for prognostication of the natural and therapeutic course, i.e., therapy control (angioplasty, bypass, lysis, cardiac drugs). More marginal but upcoming clinical indications are mentioned, such as progressive systemic sclerosis cardiac transplantation, pediatric cardiology, and problems of nephrology/urology. The ''normal'' values and the impact of digital radiology and of contrast cardiography are touched upon. Preliminary cases with /sup 111/In-antimyosin and /sup 99m/TC-Isonitriles are presented including correlative results between globla ejection fraction determination according to gated /sup 99m/Tc-isonitrile and conventional /sup 99m/Tc-erythrocyte ventriculogram (r=0,75; n=10).

  8. Daily liquorice consumption for two weeks increases augmentation index and central systolic and diastolic blood pressure.

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    Miia H Leskinen

    Full Text Available Liquorice ingestion often elevates blood pressure, but the detailed haemodynamic alterations are unknown. We studied haemodynamic changes induced by liquorice consumption in 20 subjects versus 30 controls with average blood pressures of 120/68 and 116/64 mmHg, respectively.Haemodynamic variables were measured in supine position before and after two weeks of liquorice consumption (daily glycyrrhizin dose 290-370 mg with tonometric recording of radial blood pressure, pulse wave analysis, and whole-body impedance cardiography. Thirty age-matched healthy subjects maintaining their normal diet were studied as controls.Two weeks of liquorice ingestion elevated peripheral and central systolic and diastolic blood pressure (by 7/4 and 8/4 mmHg, 95% confidence intervals [CI] 2-11/1-8 and 3-13/1-8, respectively, P<0.05, and increased extracellular volume by 0.5 litres (P<0.05 versus controls. Also augmentation index adjusted to heart rate 75/min (from 7% to 11%, 95% CI for change 0.3-7.5, P<0.05 and aortic pulse pressure (by 4 mmHg, 95% CI 1-7, P<0.05 were elevated indicating increased wave reflection from the periphery. In contrast, peripheral (-3/-0.3 mmHg and central blood pressure (-2/-0.5 mmHg, aortic pulse pressure (-1 mmHg, and augmentation index adjusted to heart rate 75/min (from 9% to 7% decreased numerically but not statistically significantly without changes in extracellular volume in the control group. Heart rate, systemic vascular resistance, cardiac output, and pulse wave velocity did not differ between the groups.Two weeks of daily liquorice consumption increased extracellular volume, amplified pressure wave reflection from the periphery, and elevated central systolic and diastolic blood pressure.EU Clinical Trials Register EudraCT 2006-002065-39 NCT01742702.

  9. Maternal functional hemodynamics in the second half of pregnancy: a longitudinal study.

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    Åse Vårtun

    Full Text Available Cardiovascular response to passive leg raising (PLR is useful in assessing preload reserve, but it has not been studied longitudinally during pregnancy. We aimed to investigate gestational age associated serial changes in maternal functional hemodynamics and establish longitudinal reference ranges for the second half of pregnancy.This was a prospective longitudinal study on 98 healthy pregnant women who were examined 3-5 times during 20-40 weeks of gestation (a total of 441 observations. Maternal cardiac function and systemic hemodynamics were assessed at baseline and 90 seconds after PLR using impedance cardiography (ICG. The main outcome measures were gestational age specific changes in ICG-derived variables of maternal cardiovascular function and functional hemodynamic response to PLR.Hemodynamic response to PLR varied during pregnancy. PLR led to an insignificant increase in stroke volume during 20+0 to 31+6 weeks, but later in gestation the stroke volume was slightly lower at PLR compared to baseline. PLR caused no significant change in cardiac output between 20+0 and 23+6 weeks and a significant decrease after 24+0 weeks. A decrease in heart rate, mean arterial pressure, and cardiac contractility was observed during PLR throughout the second half of pregnancy. Systemic vascular resistance was reduced by PLR up to 32+0 weeks, but increased slightly thereafter.Healthy pregnant women appear to have limited preload reserve and reduced cardiac contractility, especially in the third trimester, which makes them vulnerable to fluid overload and cardiac failure.

  10. Hepatic hemodynamics and fetal growth: a relationship of interest for further research.

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    Sharona Vonck

    Full Text Available It is well known that hepatic hemodynamics is an important physiologic mechanism in the regulation of cardiac output (CO. It has been reported that maternal cardiac output relates to neonatal weight at birth.In this study, we assessed the correlation between maternal hepatic vein Doppler flow parameters, cardiac output and neonatal birth weight.Healthy women with uncomplicated second or third trimester pregnancy attending the outpatient antenatal clinic of Ziekenhuis Oost-Limburg in Genk (Belgium, had a standardized combined electrocardiogram-Doppler ultrasound with Impedance Cardiography, for measurement of Hepatic Vein Impedance Index (HVI  =  [maximum velocity - minimum velocity]/maximum velocity, venous pulse transit time (VPTT  =  time interval between corresponding ECG and Doppler wave characteristics and cardiac output (heart rate x stroke volume. After delivery, a population-specific birth weight chart, established from a cohort of 27000 neonates born in the index hospital, was used to define customized birth weight percentiles (BW%. Correlations between HVI, VPTT, CO and BW% were calculated using Spearman's ρ, linear regression analysis and R2 goodness of fit in SPSS 22.0.A total of 73 women were included. There was a negative correlation between HVI and VPTT (ρ = -0.719, p < 0.001. Both HVI and VPTT correlated with CO (ρ = -0.403, p < 0.001 and ρ = 0.332, p < 0.004 resp. and with BW% (ρ =  -0.341, p < 0.003 and ρ = 0.296, p < 0.011 resp..Our data illustrate that the known contribution of hepatic hemodynamics in the regulation of cardiac output is also true for women with uncomplicated pregnancies. Our study is the first to illustrate a potential link between maternal hepatic hemodynamics and neonatal birth weight. Whether this link is purely associative or whether hepatic vascular physiology has a direct impact on fetal growth is to be evaluated in more extensive clinical and experimental research.

  11. Preoperative CT scanning of 70 cases of rheumatic valvular disease

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    Take, Akira; Matuzaki, Shigeru; Oki, Shinichi (Jichi Medical School, Minamikawachi, Tochigi (Japan)) (and others)


    Seventy patients with rheumatic valvular disease were evaluated with preoperative CT scanning. The correlation of the obtained CT images to the operative findings were examined. Left atrial thrombi were found in 24 cases at the operation. CT scan had detected thrombi in 19 cases (79.2%) and echocardiography in 15 (62.5%). CT failed to find them in 5 cases in which the left atrial thrombi were less than 3 g. Echocardiogram, however, failed to detect thrombi in 9 cases, the largest being 14 g. There were 15 cases with left atrial calcification, in which 10 cases had left atrial thrombi. Nine cases out of these 10 cases had rough left atrial surface after thrombectomy. Early postoperative CT of 10 with left atrial calcification showed recurrent left atrial thrombi in 4 (40%) cases. Mitral valve calcification was found in 42 cases during operation. CT scan was able to detect it in 40 (95.2%), while echocardiogram detected in 34 cases (81.0%) (p<0.05). All mitral valves with calcification required replacement. Out of 30 cases with non calcified mitral valves, 9 underwent OMC, and the other 21 underwent mitral valve replacement. Aortic valve calcification was found in 9 out of 11 cases of aortic stenosis. All has been diagnosed by CT scan. In conclusion, 1. in detecting the left atrial thrombi, CT scan was superior to echo-cardiography, and provided useful information for planning the operative procedure including atrial approach and valvular manipulation, 2. CT scan could detect calcification of left atrial wall which had high incidence of thrombus formation and rough left atrial surface, 3. CT scan could detect calcification of both mitral and aortic valve, and showed the severity of valvular structural changes. (author).


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    Full Text Available Context ( Back ground Acute Rheumatic fever and Rheumatic heart disease are the most common acquired childhood heart disease in India. It is well established that 2 D Echo cardiography is more sensitive in picking up minor degrees of valvular regurgitation than clinical examination . AIMS & OBJECTIVES: To study the clinical profile of “Rheumatic Fever and Rheumatic heart disease“ & correlate it with Echocardiographic fin dings in Children under 15 years age group presenting to a tertiary care hospital. MATERIALS AND METHODS OF STUDY: Thirty six cases of Acute Rheumatic fever, which includes eight cases of first attack and twenty eight cases of reactivation of Rheumatic fev er were studied over a period of two years in paediatric medical wards, King George Hospital, Visakhapatnam. The revised (1992 modified Jones criteria with the 1988 WHO modification was taken as a criterion to diagnose Acute Rheumatic fever . RESULTS : Peak age of Acute Rheumatic fever and Chronic Rheumatic heart disease is between 5 - 10 years (55.8%. No sex variation has been observed. Fever and joint involvement are the most common clinical manifestations (87.5%each in first attack cases. Active cardi tis (75% the second most common manifestation , followed by arthralgia (25% and sore throat (25% , chorea , chest pain , abdominal pain were infrequent manifestations found to be 12.5% each. None of the cases had Erythema marginatum. CONCLUSION : In the pres ent study the clinical findings were correlated with that of previous studies and Echocardiographic findings were correlated well as far as moderate to severe lesions. Further Echocardiography was proved to be more sensitive in detecting even trivial or mi ld aortic regurgitation and mitral or aortic stenosis.

  13. The maternal venous system: the ugly duckling of obstetrics. (United States)

    Tomsin, K


    In pregnancy, both maternal vascular tone and cardiac function are considered key players to reach a normal outcome for both mother and child. This complex story of maternal hemodynamics is intensely discussed in current scientific literature, however the role of the maternal veins has been strongly underestimated. We developed and evaluated a set of measurable objective parameters which give an indication of venous function, i.e. the venous impedance index and the venous pulse transit time. These parameters turned out to be subject to changes throughout normal pregnancy and in preeclampsia enabling their use in gestational hemodynamic -studies. From our studies, we concluded that the venous system is a crucial determinant of cardiac output, which can be estimated by impedance cardiography. The introduction of these non-invasive techniques in obstetrics enables profiling the maternal cardiovascular system, integrating both arteries and veins, as well as maternal cardiac -function. Studying the cascade of cardiovascular changes throughout pregnancy using such non-invasive, easily applicable, and highly accessible methods opens perspectives to introduce this maternal cardiovascular profile in several -clinical settings. The early discrimination between low and high risk patients, together with the classification of different pregnancy disorders may help guiding the clinical work-up of the pregnant population regarding both prevention and treatment, as well as follow-up. We illustrate that the venous system, being an "ugly duckling" at first neglected by the medical world, transforms and matures into a beautiful swan, accepted by the obstetric world. We are confident that this is the beginning of many other studies regarding the maternal venous system, an important piece of the gestational physiology puzzle.

  14. A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves

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    Konings Maurits K


    Full Text Available Abstract Background In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP is presented, that measures the average stroke volume (SV for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. Methods ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo. These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds. The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. Results The ex-vivo measurements showed that ventricular filling

  15. Experience of treatment of heart rhabdomyomas in combination with various arrhythmias and conduction disorders

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    Bockeria L. A.


    Full Text Available Оbjective. Presentation the experience of diagnosis and treatment of heart rhabdomyomas in combination withvarious arrhythmias and conduction disorders.Material and methods. In archival material found 9 records of pediatric patients treated in A.N. BakoulevCenter for Cardiovascular Surgery from June 2004 to September 2013 with cardiac rhabdomyomas. The ageofpatients ranged from 19 days to 17 years. Along with the general clinical studies patients perfomed electro-cardiography (ECG, Holter ECG, echocardiography with doppler, computed tomography (CT and cardiacmagnetic resonance imaging (MRI with contrast. Rhabdomyomas localized in the left ventricle with3patients, in the right ventricle with 3 patients, in the right atrium – 2 patients and in the left atrium –1patient. Intramural and mixed rhabdomyomas growth was accompanied by a variety of arrhythmias andconduction of the heart, which were observed in 6 patients. Among them one cases were registered: manifesting Wolff–Parkinson–White syndrome, continuous recurrent atrial tachycardia, atrial fibrillation/flutter,full blockade of the right bundle branch, atrioventricular (AV block 3rd degree, a weakness syndrome sinusnode and paroxysmal atrial tachycardia.Results. Surgical care was performed in 5 cases. In 4 cases the tumor was unresectable or surgical treatment has not been shown. These patients were released under the supervision of a cardiologist at the place of residence on drug therapy. The most frequent localization rhabdomyomas of the heart – the ventricles(66.7%. Rhabdomyomas of the heart in combination with disorders of rhythm and conduction was observedin 6 patient (66.7%. Surgery included resection of rhabdomyomas of the heart under conditions of artificialblood circulation and pharmacological cardioplegia. Patient with atrial fibrillation/flutter in 1 cases was performed radiofrequency modification operation Cox Maze. In this group of patients in-hospital mortality is 0


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    Full Text Available BACKGROUND: Cardio vascular malformations are the most common congenital malformations. Early recognition of congenital heart disease is important in the neonatal period, as many of them may be fatal if undiagnosed. AIM : To study the epidemiology of neonatal cardiac murmurs. To identify clinical characteristics which differentiates pathological murmur from functional murmurs to assess the reliability of clinical evaluation in diagnosing congenital heart diseas e? METHODS : The study population included all neonates admitted in a Hospital in Visakhapatnam to the NICU, postnatal ward, attending pediatric OPD and were detected to have cardiac murmurs. It was a cross sectional study over a period of 16 months. A clinical diagnosis was made based on history and clinical examination. Then Chest X ray and ECG were done in symptomatic infants. Echo cardiography was done in all neonates for confirmation of diagnosis, the neonates were again examined daily till they were in hospital and during the follow up visit at 6 weeks. RESULTS : A total of 61 neonates were included and was conducted over a period of 16 months . T he incidence of cardiac murmurs among intramural neonates was 13.5 for 1000 live births. Most frequent symptom was fast breathing in 10[16.4%] cases. VSD was the most common diagnosis clinically in 19[31.47%] babies. The most frequent diagnosis was acyanotic complex congenital heart disease, Only intra mural neonates were considered for the incidence of murmurs and the incidence of cardiac murmurs among them babies was 13.5 for 1000 live in 23[37.7%] cases followed by 10[16.4%] cases each of VSD and ASD respectively. Overall in our study 73.77% [45 cases] of the murmurs were diagnosed correctly and confirmed by Echocardiography. INTERPRETATIONS & CONCLUSIONS: 1. It is possible to make clinical diagnosis in many cases of congenital heart diseases. 2. The functional murmurs could be differentiated from those arising from structural heart

  17. The significance of amlodipine on autonomic nervous system adjustment (ANSA method: A new approach in the treatment of hypertension

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    Milovanović Branislav


    Full Text Available Introduction. Cardiovascular autonomic modulation is altered in patients with essential hypertension. Objective To evaluate acute and long-term effects of amlodipine on cardiovascular autonomic function and haemodynamic status in patients with mild essential hypertension. Methods. Ninety patients (43 male, mean age 52.12 ±10.7 years with mild hypertension were tested before, 30 minutes after the first 5 mg oral dose of amlodipine and three weeks after monotherapy with amlodipine. A comprehensive study protocol was done including finger blood pressure variability (BPV and heart rate variability (HRV beat-to-beat analysis with impedance cardiography, ECG with software short-term HRV and nonlinear analysis, 24-hour Holter ECG monitoring with QT and HRV analysis, 24-hour blood pressure (BP monitoring with systolic and diastolic BPV analysis, cardiovascular autonomic reflex tests, cold pressure test, mental stress test. The patients were also divided into sympathetic and parasympathetic groups, depending on predominance in short time spectral analysis of sympathovagal balance according to low frequency and high frequency values. Results. We confirmed a significant systolic and diastolic BP reduction, and a reduction of pulse pressure during day, night and early morning hours. The reduction of supraventricular and ventricular ectopic beats during the night was also achieved with therapy, but without statistical significance. The increment of sympathetic activity in early phase of amlodipine therapy was without statistical significance and persistence of sympathetic predominance after a few weeks of therapy detected based on the results of short-term spectral HRV analysis. All time domain parameters of long-term HRV analysis were decreased and low frequency amongst spectral parameters. Amlodipne reduced baroreflex sensitivity after three weeks of therapy, but increased it immediately after the administration of the first dose. Conclusion. The results

  18. Interventional treatment of common congenital heart diseases the common view of Chinese medical experts.Part Two——Interventional treatment of ventricular septal defect%常见先天性心脏病介入治疗中国专家共识二、室间隔缺损介入治疗

    Institute of Scientific and Technical Information of China (English)



    室间隔缺损(VSD)为最常见的先天性心脏畸形,占先天性心脏病的25% ~ 30%.介入治疗的关键在于适应证的选择,操作技巧和并发症的防治.根据左心室造影图像判断VSD的形态和类型,选择不同类型的封堵器.操作中要避免右房室瓣腱索的缠绕、瓣膜的损伤和心律紊乱的发生.术后应严密观察,及早处理房室传导阻滞等并发症.本文详细介绍了膜部和肌部VSD的诊断,规范化的操作方法,术中和术后可预测的情况处理.%Ventricular septal defect(VSD)is the most common congenital heart disease. it accounts for 25 ~ 30% of all congenital heart diseases. The key points of interventional treatment for VSD are the careful selection of indications. the rich experience in manipulating skill and the effective prevention of complications. According to the imaging f'indings on the selective left sided cardiography and echocardiography, the morphology and type of VSD, mainly including the precise size and location of the defect. can be accurately determined. on this account the proper transcatheter device closure can be rationally selected. During the interventional management, the twine and damage of the right atrio-ventricular valve as well as its tendinous cords should be avoided. and the ventricular arrhythmias and new aortic or tricuspid regurgitation should be prevented. After the treatment, the patient should be closely observed, the postoperative complications such as atrioventricular block should be promptly dealt with. In this chapter, the diagnosis of membranous and muscular VSD. the standard interventional procedure of transcatheter device closure implantation and the management of predictable events occurred during and after the procedure will be systemically described. (J Intervent Radiol, 2011 , 20 : 87-92)

  19. Cardiac output measured by electrical velocimetry in the CT suite correlates with coronary artery enhancement: a feasibility study

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    Flinck, Marianne; Graden, Aasa; Milde, Helen; Flinck, Agneta; Hellstroem, Mikael (Dept. of Radiology, Sahlgrenska Univ. Hospital and Sahlgrenska Academy at Goetenborg Univ., Goeteborg (Sweden)); Bjoerk, Jonas (Competence Centre for Clinical Research, Lund Univ. Hospital, Lund (Sweden)); Nyman, Ulf (Dept. of Radiology, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden)), e-mail:


    Background: Cardiac output (CO) is inversely related to vascular contrast medium (CM) enhancement during computed tomography (CT). Impedance cardiography with a new technique, electrical velocimetry (EV), may create opportunities to measure CO pre-examination for adaptation of CM injection parameters. Purpose: To relate COEV measured by radiology staff to aortic attenuation as a measure of coronary artery attenuation during CT coronary angiography (CTCA), and to formulate a tentative statistical model to adapt CM injection parameters to CO. Material and Methods: COEV was measured immediately before 100 kVp CTCA (64-multirow detector) in 27 patients with presumed coronary artery disease. For CTCA, 260 mg I/kg (maximum dosage weight: 80/90 kg for women/men) was injected intravenously during 12 s. Simple linear regression analysis was performed to explore the correlation between aortic attenuation (Hounsfield units, HU) and body weight, the influence of COEV on aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s), and to establish a tentative formula on how to adapt CM injection parameters to COEV and desired aortic attenuation. Results: The correlation between aortic attenuation and body weight was weak and non-significant (r=-0.14 after outlier exclusion). A significant negative correlation (r=-0.63) was found between aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s) and COEV. The resulting formula, CM dose rate=COEVx(aortic attenuation-240)/55, made it possible to calculate CM volumes and injection rates at various COs and, for example, the present mean aortic attenuation (438 HU), injection time (12 s), CM concentration (320 mg I/ml), and a certain body weight. Conclusion: EV makes it possible to measure CO in the CT suite before vascular examinations. Hence, CM doses may be decreased in low CO states to reduce the risk of CM-induced nephropathy without jeopardizing diagnostic quality and may be increased in high CO states

  20. Network design for telemedicine--e-health using satellite technology. (United States)

    Graschew, Georgi; Roelofs, Theo A; Rakowsky, Stefan; Schlag, Peter M


    Over the last decade various international Information and Communications Technology networks have been created for a global access to high-level medical care. OP 2000 has designed and validated the high-end interactive video communication system WinVicos especially for telemedical applications, training of the physician in a distributed environment, teleconsultation and second opinion. WinVicos is operated on a workstation (WoTeSa) using standard hardware components and offers a superior image quality at a moderate transmission bandwidth of up to 2 Mbps. WoTeSa / WinVicos have been applied for IP-based communication in different satellite-based telemedical networks. In the DELTASS-project a disaster scenario was analysed and an appropriate telecommunication system for effective rescue measures for the victims was set up and evaluated. In the MEDASHIP project an integrated system for telemedical services (teleconsultation, teleelectro-cardiography, telesonography) on board of cruise ships and ferries has been set up. EMISPHER offers an equal access for most of the countries of the Euro-Mediterranean area to on-line services for health care in the required quality of service. E-learning applications, real-time telemedicine and shared management of medical assistance have been realized. The innovative developments in ICT with the aim of realizing a ubiquitous access to medical resources for everyone at any time and anywhere (u-Health) bear the risk of creating and amplifying a digital divide in the world. Therefore we have analyzed how the objective needs of the heterogeneous partners can be joined with the result that there is a need for real integration of the various platforms and services. A virtual combination of applications serves as the basic idea for the Virtual Hospital. The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre


    Directory of Open Access Journals (Sweden)

    Venkata Arunavalli


    Full Text Available BACKGROUND : The incidence of congenital heart disease is 0.8 in 1000 live births. Fetal echo cardiography offers a chance to detect most hemodynamically significant congenital heart disease in early pregnancy, so that their management prenatally, at birth and postnatally can be planned better. OBJECTIVES : To analyze the profile of congenital heart disease as diagnosed by fetal echocardiography, in pregnant women referred to a tertiary care centre. MATERIAL AND METHODS : The study design is retrospective, observational study. A total number of 583 fetal echo studies were performed at our C entre from January 1 st 2014 to June 30 th 2015. All studies were performed by a single operator. The main i ndications for the referral were: inability to visualize a clear four chamber view on obstetric scan, echogenic focus in LV cavity, maternal diabetes, family history of congenital heart disease, and maternal request. Statistical analysis was performed usin g statistical package for social sciences SPSS: CHICAGO, 3L VSA program. All the women with abnormal FE studies, except ones with complex CHDS were instructed to bring the new borns for 2D echo within 1 – 2 days after birth. RESULTS : Overall, significant C HD was found in 5.4% of FE studies (32 out of 583 cases . The most common indications for referral were: inability to visualize a clear four chamber view on obstetric scan, echogenic focus in LV cavity, maternal diabetes, family history of congenital heart disease, and maternal request. The risk factors with highest yield of CHD were poly hydroamnios and maternal diabetes. The commonest lesion found was ostium secundum ASD. There was a significant correlation between the presence of echogenic focus prenatal ly and small to moderate sized ostium secundum ASD after birth. CONCLUSION : Our data suggests that the risk factors with highest yield of CHD are polyhydromnios and meternal diabetes. Presence of echogenic focus in the LV in FE is associated

  2. [Guideline (S2k, AWMF) of the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin and the Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin "Diagnostics and Expert Opinion in the Occupational Disease No. 4101 Silicosis (Including Coal Worker's Pneumoconiosis)"]. (United States)

    Baur, X; Heger, M; Bohle, R M; Hering, K G; Hofmann-Preiß, K; Nowak, D; Tannapfel, A; Teschler, H; Voshaar, T; Kraus, T


    (and sometimes mediastinial) lymph nodes; according to the guideline working group they do not closely correlate with the degree of pulmonary involvement. Extended conglomerating and enduring lymph-node processes may lead to dislocation of the hili with impairment of large bronchi and vessels. Shell-like calcifications dominating in the periphery of lymph nodes produce so-called egg-shell hili.The paragraph on exercise testing is now extended: if neither ergometry nor spiroergometry can be performed a 6 minute walking test by measuring oxygen saturation should be done.Furthermore, in individual expert opinion examinations right heart catheterization (the patient is not obliged to give informed consent) may be recommended, if echo cardiography gives evidence for pulmonary hypertension or if it is difficult to differentiate between right and left heart failure. The presence of pulmonary hypertension which is of prognostic relevance has to be considered when grading reduction in earning capacity.For interpretation of spirometry values the new GLI reference values has to be applied. Grading of impairment is due to the recommendation of the DGP.According to current medical scientific knowledge it is unclear, whether certain disorders of the rheumatic group such is scleroderma or Caplan syndrome which are sometimes associated with silicosis (or coal workers' pneumoconiosis) belong in toto to the occupational disease number 4101 (silicosis). Within this context, additional studies are needed to clarify the role of occupational quartz exposure and other risk factors.The guideline working group hopes that this update will help to optimize diagnostics and expert opinion of silicotic patients.

  3. Comparing the accuracy of ES-BC, EIS-GS, and ES Oxi on body composition, autonomic nervous system activity, and cardiac output to standardized assessments

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    Lewis JE


    < 0.001. Absolute agreement was found at baseline and after both bouts of exercise; ES Oxi overestimated baseline and stage 1 exercise cardiac output by 0.3 L/minute and 0.1 L/minute, respectively, but exactly estimated stage 2 exercise cardiac output. Conclusion: ES-BC and ES Oxi accurately assessed body composition and cardiac output compared to standardized instruments, whereas EIS-GS showed marginal predictive ability for autonomic nervous system activity. The ESC software managing the three devices would be useful to help detect complications related to metabolic syndrome, diabetes, and cardiovascular disease and to noninvasively and rapidly manage treatment follow-up. Keywords: fat mass, autonomic nervous system activity, Electro Sensor Complex, dual-energy X-ray absorptiometry, heart rate variability, and bioimpedance cardiography

  4. Angiography of double outlet of right ventricles%右心室双出口的心血管造影诊断

    Institute of Scientific and Technical Information of China (English)

    申玉良; 侯爱军; 武艳强; 袁芳


    目的 评价心血管造影对右心室双出口的诊断价值.方法 收集11例右心室双出口患者的临床及心血管造影资料并进行回顾性分析.全部患者均行X线、心电图、超声心动图心导管及心血管造影检查.结果 所有患者的心血管造影诊断与术后诊断完全相符,符合率为100%.11例主动脉、肺动脉同时显影,两大动脉起自右心室.8例室间隔缺损,3例心内膜垫缺损.其中5例室间隔缺损位于肺动脉瓣下,同时并右冠状动脉异位开口;3例室间隔缺损位于主动脉、肺动脉之间,同时合并左右心房互换、永存左上腔静脉;2例室间隔缺损远离肺动脉和主动脉,肺动脉发育差.另1例心内膜垫缺损合并二尖瓣、三尖瓣重度关闭不全.结论 心血管造影对右心室双出口及合并畸形可做出较准确诊断.%Objective To report 11 cases of double outlet of right ventricles and to evaluate the methods of angiography.Methods Angiocardiographies of 11 patients were collected.All patients underwent X-ray film,electro-cardiography,echocardiography,cardiac catheterization and angiocardiography.Results The coincidence rate between angiography and operation was 100%.Angiographies were performed in 11 patients.Both great arteries(Aorta and Pulmonary Artery) originated from the right ventricle in all the cases.8 patients had ventricular septal defect(VSD) and 3 patients had endocardial cushion defect.Five cases of the VSDs were found under the valve of pulmonary artery and were accompanied with anomalous origin of the right coronary artery;3 cases of the VSDs were found to be between the aorta and pulmonary artery and were accompanied with position interchange of two atria and persistent left superior vena cava;2 eases of the VSDs were found being away from aorta and pulmonary artery as well as agenesis of pulmonary artery.The last case of the endocrinal cushion defect were accompanied with mitral valve insufficiency and severe

  5. Valvular heart disease with giant left ventricle by valve replacement%心瓣膜病合并巨大左心室44例实施瓣膜置换术效果观察

    Institute of Scientific and Technical Information of China (English)

    魏蜀亮; 梁敏; 邓志刚; 谢俊豪


    目的 分析心瓣膜病合并巨大左心室患者的外科治疗经验,提高瓣膜置换术后的疗效.方法 对44例心瓣膜病变合并巨大左心室患者实施瓣膜置换术,其中二尖瓣置换术20例,主动脉瓣置换术14例,二尖瓣+主动脉瓣置换术10例.同时实施三尖瓣成形术13例,左房折叠成形术5例,左房血栓清除术12例.结果 术后早期死亡3例(6.8%),死亡原因为心室颤动、低心排出量综合征、肺水肿并呼吸衰竭,其余妇例均生存;术后随访6~12个月,超声心动图提示左室舒张末期内径(LVEDD)为65~102 mm,平均(68.3±0.39)mm,较术前均有不同程度的缩小;心功能改善Ⅰ级6例、Ⅱ级35例.结论 巨大左心室是影响心瓣膜置换手术疗效的重要因素之一.充分的术前准备,术中良好的心肌保护加上恰当的瓣膜处理及严密的术后监护对提高巨大左心室心瓣膜置换术患者疗效至关重要.%Objective To review our experience of operation for patients with valvular heart disease and giant left ventricle in order to improve the results of valve replacement operation. Methods We retrospectively analyzed the clinical data of 44 cases of valvular heart disease with giant left ventricle treated by valve replacement operation in our hospital. Mitral valve replacement was performed for 20 cases, aortic valve replacement for 14 cases, and double valves replacement for 10 cases. Meanwhile 13 cases underwent bicuspid valve plasty , 5 underwent left atrial plication , and 12 underwent left atrial thrombus removal. Results There were 3 cases of early death after operation (6. 8% ) , mainly due to postoperative ventricular fibrillation, low cardiac output syndrome, pulmonary edema, and respiratory failure. The other 41 survived. Follow-up was carried out for 6 ~ 12 months. The left ventricular enddiastolic diameter ranged from 65 to 102 mm (68. 3 ±0. 39) according to ultrasonic cardiography, which decreased in certain degrees compared

  6. 右美托咪定镇静对老年患者血流动力学的影响%Effects of dexmedetomidine on hemodynamics in the elderly patients

    Institute of Scientific and Technical Information of China (English)

    吕丹; 皋源; 杭燕南


    目的 评估右美托咪定持续静脉输注10 min对SICU老年患者血流动力学的影响.方法 选择全麻术后入SICU的患者38例,按照年龄分为老年组(年龄65~80岁,n=18)和中青年组(年龄18~64岁,n=20).在患者术后Ramsay评分≤3分时持续静脉输注右美托咪定6.0μg·kg-1·h-1 10 min后停药,应用阻抗心动图记录用药前即刻(基础值)及用药后5、10、30和60 min的SBP、DBP、HR、心脏指数(CI)、每搏量(SV)、外周循环阻力(SVR)、心室收缩加速度指数(ACI)及Ramsay评分.结果 两组用药后达到Ramsay评分为3分的时间差异无统计学意义,但老年组Ramsay评分持续在3分以上的时间为(62.28±24.79)min,长于中青年组的(40.57±19.19)min(P<0.05).与基础值相比,用药后两组SBP、DBP、HR和CI下降(P<0.05),而SV和ACI差异无统计学意义.结论 持续静脉输注右美托咪定6.0μg·kg-1·h-1用于SICU老年患者镇静时,可引起CI、BP下降和HR减慢.%Objective To investigate the effects of continuous intravenous dexmedetomidine on hemodynamics in the SICU elderly postoperative patients. Methods Thirty-eight postoperative patients underwent abdominal or thoracic surgeries under general anaesthesia were selected into two groups: the elderly group (65-80 years old, n=18) and the young group (18-64 years old, n=20).Dexmedetomidine 6.0 μg· kg-1 ·h-1 was intravenously infused for 10 minutes when Ramsay sedation scale was≤3 after operation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), and acceleration index (ACI) were monitored by impedance cardiography and Ramsay sedation scale (RSS) was recorded before infusion (baseline) and at 5, 10, 30 and 60 min after dexmedetomidine administration. Results The time of RSS of 3 had no significant difference between the two groups.While the duration of RSS above 3 was longer in elderly group [(62.28

  7. 优化起搏参数在提高心脏再同步化治疗疗效中的作用%Study on significance of optimal pacemaker parameters in improving the efficacy of cardiac resynchronization therapy

    Institute of Scientific and Technical Information of China (English)

    谢芳; 何亚峰; 邓成钢; 程光辉; 张劲林


    Objective To evaluate the efficacy of cardiac resynchronization therapy( CRT)in treatment of patients with AV or VV delay. Methods Forty-nine patients with chronic heart failure received cardiac resynchronous pacing,followed-up for 1 week,3 months,6 months and 1 year,the delay of AV had been optimized by ultrasound cardiography,and delay of VV had been optimized by tissue Doppler imaging. Re-sults Heart function in 45 cases had been improved after CRT. According to NYHA classification,these patients had been improved from classⅢ˜IV to class II˜III,and their 6 minutes walking distance had also been increased. The LVEF index and VTI of left ventricular systolic func-tion had been improved( P <0. 01). Left ventricular diastolic filling time was also increased. In 3 months and 6 months after the treatment,left ventricular end diastolic diameter and volume were significantly smaller than those before the treatment( P <0. 01,P <0. 05). Mitral regurgita-tion had been reduced,and the standard deviation of 12 segments time to peak had been decreased from(139 ± 33)ms to(110 ± 40)ms( P <0. 01). Conclusion Optimization of the pacemaker parameters is needed in order to enhance the efficacy of CRT.%目的:探讨优化A-V、V-V间期在提高心脏再同步化治疗( CRT)中的疗效。方法49例CRT治疗的慢性心力衰竭患者,于术后1周、3个月、6个月和12个月进行个体化参数程控(在超声心动图指导下优化A-V间期,在组织多普勒显像下优化V-V间期),观察心脏同步性和心功能变化,达到CRT最佳治疗目的。结果临床症状:45例CRT后心功能得到改善,心功能NYHA分级,从Ⅲ˜Ⅳ级提高为Ⅱ˜Ⅲ级,6分钟步行距离增加。超声指标:反映左室收缩功能的指标左室射血分数( P <0.01)、血流速度积分( VTI)增加,反映左室舒张功能的指标左室舒张充盈时间延长,评价心腔大小指标改善,术后3、6个月左心室舒张末期内

  8. 感染性心内膜炎赘生物超声心动图诊断的临床研究%Clinical study on infective endocarditis vegetations transthoracic echocardiography diagnosis

    Institute of Scientific and Technical Information of China (English)

    黄楠; 徐永通; 李建华; 张红


    目的:探讨超声心动图诊断感染性心内膜炎赘生物的临床价值,以期提高临床诊治水平。方法选取2005年1月-2013年4月46例感染性心内膜炎赘生物患者为研究对象,均采用超声心动图检查,所有患者均行手术治疗,手术后对病理产物进行病理诊断,比较经胸超声心动图检查诊断结果和手术病理诊断结果的符合度情况,采用SPSS13.0软件进行分析。结果超声心动图与手术诊断进行比较,总符合率为95.65%,其中1例主动脉瓣+三尖瓣瓣根处有赘生物,超声心动图诊断为右心室结节,另外1例瓣膜脱垂,超声心动图诊断为右冠瓣穿孔。结论超声心动图对感染性心内膜炎赘生物诊断准确率高,作为一种无创的诊断方法,对临床感染性心内膜炎赘生物高危人群具有较高的筛选价值,早确诊、早治疗,提高该类患者的治疗预后具有较高的价值和临床意义。%OBJECTIVE To investigate the clinical value of infective endocarditis vegetation by transthoracic echo-cardiographic diagnosis in order to improve the clinical diagnosis and treatment .METHODS From Jan 2005 to Apr 2013 ,a total of 46 cases of patients with infective endocarditis vegetation were selected as the objects of study .All were examined by transthoracic echocardiography and underwent surgery .After surgery ,they had pathological product diagnosis , so as to compare the compliance of transthoracic echocardiography diagnosis and surgical pathology results by SPSS13 .0 software .RESULTS The diagnosis and surgery were compared ;the total coinci-dence rate was 95 .65% ,including one case with vegetations at aortic root and tricuspid valve root ;transthoracic echocardiography diagnosis found right ventricular nodules ,while another case had valvular prolapse ;the tran-sthoracic echocardiography showed the right coronary leaflet perforation .CONCLUSION The transthoracic echo-cardiography has

  9. Clinical Observation of Ambrisentan in Treatment of 42 Patients with Pulmonary Artery Hypertension%安立生坦治疗肺动脉高压42例临床观察

    Institute of Scientific and Technical Information of China (English)

    刘洋; 张刚成; 周红梅; 尚小珂


    目的:观察安立生坦治疗肺动脉高压( pulmonary arterial hypertension, PAH)临床疗效。方法2011年4月-2013年10月在武汉亚洲心脏病医院住院的PAH 89例,将应用安立生坦治疗的42例作为治疗组,将仅采用基础治疗的47例作为对照组,于治疗前及治疗12周后测量两组6 min步行距离、超声心动图测量指标、WHO肺动脉高压心功能分级( WHO FC)以及血浆B型钠尿肽( BNP)以及血常规和生化指标的变化情况。结果治疗12周后治疗组6 min步行距离较治疗前和对照组增加,BNP和血清总胆红素水平较治疗前和对照组下降( P0.05)。治疗组无死亡病例,不良反应轻微,其中下肢水肿者给予利尿剂好转,其他均自行缓解。对照组死亡2例,均为猝死。结论安立生坦可显著改善PAH患者心功能及运动耐力,安全性和耐受性良好。%Objective To observe clinical efficacy of Ambrisentan in treatment of pulmonary arterial hyperten-sion (PAH). Methods A total of 89 patients with PAH were divided into Ambrisentan group (42 inpatients treated with Ambrisentan) and control group (47 patients treated with basal therapy) during April 2011 and October 2013 in Wuhan Asia Heart Hospital, and indexes of the 6-min walking distance (6-MWD), ultrasonic cardiography (UCG), WHO PAH functional classification ( WHO FC) , brain natriuretic peptide ( BNP) , routine blood test and biochemistry were detected before and after Ambrisentan treatment for 12 weeks, and then its safety was evaluated. Results In Ambrisentan group, the value of 6-MWD after treatment for 12 weeks was increased, but the levels of BNP and serum total bilirubin were de-creased compared with those before treatment and in control group (P0. 05). No patients died in treatment group, and adverse reactions were mild, in which edema of lower extremity were improved by diuretics treatment, and others were spontaneous remission. Two patients in control group died of a sudden death

  10. 两种三尖瓣环成形术的近期临床效果评价%Evaluation of clinic effects after different tricuspid valvuloplasty in patients with secondary tricuspid valve insufficiency

    Institute of Scientific and Technical Information of China (English)

    褚银平; 高奇英; 张羽; 崔少鹏; 张栋


    Objectives Tricuspid valve(TV) insufficiency secondary to valvular heart disease or congenital heart disease is the most common aetiology of tricuspid regurgitation(TR). Appropriate treatment can improve long-term outcome. However, valve annuloplasty is the primary treatment for TV insufficiency. Our objective was to assess the short-term effectiveness of patients underwent tricuspid valve procedures for moderate or severe tricuspid regurgitation. These included De Vega suture tricuspid valve annuloplasty and ring annuloplasty. Methods A retrospective analysis of 65 consecutive patients with moderate to severe TR who underwent TV surgery between January 2010 and December 2012 with either a ring annuloplasty(Group Ring: n=35) or a De Vega suture annuloplasty (Group De Vega: n=30) at our hospital. The etiology for tricuspid regurgitation was rheumatic mitral and/or aortic valve diseases in 52 cases, adult atrial septal defect(ASD) in 13 cases. At different follow-up time point, the tricuspid regurgitation of all the patients was tested using ultrasound cardiography. The follow-up results were compared in 2 groups of patients. Results All patients survived from the operation. The follow up time was 0.5 to 2.6 years. The heart function improved to be NYHA class Ⅱ to Ⅲ in all patients. By 6 months after operation, right atrial diameter, right ventricle diameter and pulmonary artery systolic pressure in 2 groups was lower than the preoperative(P<0.05). However, by 2 years, pulmonary artery systolic pressure in ring group was still a downward trend(P<0.05). Echocardiography showed that trivial to mild TR was in all patients with ring annuloplasty after 6 months, and no moderate to severe TR war observed in one or two years later. By 0.5year, 1year and 2years follow up, echocardiography showed that trivial to mild TR was 83.3%, 94.5% and 88.9% respectively, and moderate TR was 16.7%, 4.5% and 11.1% respectively, but no severe TR cases in De Vega group. Conclusions In

  11. 早产儿动脉导管未闭超声参数预测早期自然关闭的价值%Evaluation of predicting the ductus arteriosus closure in preterm infants by echocardiography

    Institute of Scientific and Technical Information of China (English)

    杨正春; 冉素真; 沈红霞; 魏俊; 张焜; 黄泽君


    Objective To investigate the values of echocardiographic parameters for predicting the spontaneous closure of the ductus arteriosus in preterm infants .Methods A retrospective study of 110 preterm infants from October 2013 to October 2014 in our hospital was done .Examination was done at 1 ,3 ,7 d with echocardiography for those infants .Diameter of left atrium(LA) ,aotic root(AO) and arterial canal‐related parameters (the smallest width of ductal color Doppler flow jet and the maximum velocity at the ductus) at first .Preterm infants in this study were divided into two groups .The early patent ductus arterisus group included ones whoes ductus didn′t closed spontaneous in 7 d ,and the control group included ones whoes ductus closed spontaneous in 7 d ,and then the echocardiographic parameters between the two groups were compared .Results (1)The rates of ductus arteriosus sponta‐neous closure in preterm infants at 3 ,7 d were 70 .9% (78/110) ,78 .2% (86/110) ,respectivly .(2)When compared with the control group ,The rate of LA/AO in patent ductus arterisus group were higher than that of the control group(P<0 .01);The smallest width of ductal color Doppler flow jet in patent ductus arterisus group were bigger than that of the control group(P<0 .01);The maximum velocity at the ductus in patent ductus arterisus group were lower than that of the control group(P<0 .05) .(3)The best critical points of the LA/AO ,the smallest width of ductal color Doppler flow jet and the maximum velocity at the ductus of the spontaneous ductus arteriosus closure in preterm infants were 1 .32 mm ,2 .56 mm and 185 .5 cm/s ,respectivly .Conclusion Echo‐cardiography plays a significant role in prediction of the spontaneous closure of the ductus arteriosus in preterm infants .%目的:探讨早产儿动脉导管未闭超声参数预测早期自然关闭的价值。方法对2013年10月至2014年10月在重庆市妇幼保健院出生的早产儿110例进行前瞻

  12. 老年主动脉瓣钙化患者的临床研究%Clinical study of aortic valve calcification in elderly patients

    Institute of Scientific and Technical Information of China (English)

    李康; 杨重庆; 鲁安怀; 汪芳; 李艳; 唐国栋; 朱梅倩; 褚德发


    目的 探讨老年人主动脉瓣钙化的发生率、瓣膜功能及与老年人常见疾病的相关性.方法 对在我院查体的966例患者进行超声心动图检查,根据年龄分为老年组733例和非老年组233例,老年组根据有无主动脉瓣钙化分为钙化组526例和非钙化组207例,测量主动脉瓣有无钙化、狭窄或关闭不全,用Logistic回归分析钙化发生的危险因素.结果 (1)老年组主动脉瓣钙化发生率高于非老年组71.8%(526例)与14.6%(34例),差异有统计学意义(x2=237.10,P<0.01);(2)钙化组、非钙化组合并主动脉瓣狭窄的发生率分别为2.1%(11/526)、1.9%(4/207),差异无统计学意义(x2=0.81,P>0.05);(3)老年性主动脉瓣钙化组、非钙化组合并主动脉瓣关闭不全的发生率分别为63.3%(333/526)、19.3%(40/207),差异有统计学意义(x2=116.10,P<0.01);(4)不同疾病发生主动脉瓣钙化的相对风险(OR)分别为:高血压(OR= 2.06,95%CI:1.400~3.031)、冠心病(OR= 3.46,95%CI:2.217~5.384),糖尿病(OR=2.66,95%CI:1.652~4.278)、慢性肾脏病(OR=2.34,95%CI:1.415~3.869,P<0.01),骨质疏松(OR=2.33,95%CI:1.119~4.838).结论 老年患者主动脉瓣钙化发生率较高,多为主动脉瓣关闭不全,高血压、冠心病、糖尿病、慢性肾脏疾病、骨质疏松患者更易发生主动脉瓣钙化.%Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of

  13. 系统性红斑狼疮合并肺动脉高压患者临床特点分析%Systemic lupus erythematosus associated pulmonary arterial hypertension: clinical analysis of 91 cases

    Institute of Scientific and Technical Information of China (English)

    滕佳临; 张巍


    目的 分析系统性红斑狼疮(SLE)合并肺动脉高压(PAH)患者的临床特点和疗效.方法 对上海交通大学医学院附属仁济医院2007至201 1年91例患者的临床资料进行分析并作随访.根据首诊时患者NYHA(纽约心脏协会)心功能评级分为两组,A组:心功能1~2级,B组:心功能3~4级.结果 91例患者男女比例为2∶89,年龄(37±11)岁,SLE病程(7±6)年.10例患者PAH是SLE的首发表现.心脏彩超(UCG)估测的肺动脉收缩压(PASP)为40~128 mmHg.行右心导管(RHC)检查18例,占19.78%,导管实测PASP与UCG估测值对应性良好.91例中较多发生雷诺症49例(53.8%)、心包积液47例(51.6%)和抗RNP抗体阳性52例(57.14%).轻中度患者PASP与SLE疾病活动有正相关.观察期内死亡27例(29.67%);其中A组4例(14.8%),B组23例(85.2%).A组死因多为非心源性,B组多死于右心功能衰竭.环磷酰胺对PASP< 70 mmHg患者有一定效果.44例患者应用了各类PAH靶向药物,有显著疗效,显著延长了重症患者的生存期.结论 SLE-PAH患者主要的临床特点包括雷诺氏症、心包积液和抗RNP抗体阳性.轻中度患者PASP与SLE活动呈现正相关,环磷酰胺静脉冲击治疗能取得一定疗效,重症患者应用PAH靶向药物能显著改善预后.%Objective To explore the clinical characteristics and therapeutic efficacy of systemic lupus erythematosus (SLE) associated pulmonary arterial hypertension (PAH).Methods A total of 91 cases of SLE-PAH from 2007 to 2011 were reviewed and followed up.They were divided into 2 groups:group A:New York Heart Association (NYHA) functional class 1 and 2; group B:NYHA functional class 3 and 4.Results There were 2 males and 89 females with a mean age of 37 ± 11 years.The mean duration of SLE disease process was 7 ± 6 years.PAH was the primary symptom of SLE onset in 10 cases.Pulmonary arterial systolic pressure (PASP) as measured by ultrasonic cardiography (UCG) were between 40 to 128 mm

  14. 炎性肌病患者肺部病变特点分析%Clinical Analysis on the Features of Lung Diseases in Patients with Idiopathic Inflanunatory Myositis

    Institute of Scientific and Technical Information of China (English)

    李莉; 谢其冰; 刘怡欣; 李昕怡; 刘毅; 刘钢


    目的 探讨新诊断的多发性肌炎(PM)、皮肌炎(DM)和无肌病性皮肌炎(ADM)肺部病变发生率、临床特点及相关因素.方法 回顾性分析2008年1月-2010年7月新确诊的206例PM、DM、ADM临床表现、肺部影像学、肺功能、超声心动图和实验室指标.结果 206例患者中合并肺部病变156例,以肺间质病变(ILD)最多见,占患者总数的51.46%o.在性别、病程、是否吸烟方面合并ILD与无ILD患者相比差异无统计学意义,合并ILD患者年龄大于无ILD组.合并ILD患者呼吸困难、发热、雷诺现象、关节炎或关节痛概率增加.合并ILD组白蛋白低于无ILD组,血沉和免疫球蛋白IgM高于无ILD组.急性ILD组中女性患者及出现雷诺现象的概率高于慢性组.206例患者中死亡13例,其中周围型肺癌1例,特发性血小板减少并颅内出血1例,严重肺部感染11例;死亡患者中10例伴肺间质纤维化.合并急性ILD患者死亡率较慢性组高2倍.结论 PM、DM、ADM患者肺部病变发生率高,以ILD多见,发热、年龄大、白蛋白降低、血沉升高、雷诺现象及关节炎或关节痛都是合并ILD的相关因素.合并急性ILD患者预后差,死亡者常合并肺部感染.%Objective To explore the prevalence, clinical features, and predictive factors of pulmonary involvement in newly diagnosed polymyositis (PM), dermatomyositis (DM) and amyopathic dermatomyositis (ADM), in order to carry out early diagnosis and treatment, and improve the prognosis.Methods The clinical manifestations, chest imaging, pulmonary function test, ultrasonic cardiography and laboratory results of 206 inpatients with PM, DM and ADM in West China Hospital of Sichuan University from January 2008 to July 2010 were reviewed retrospectively.Results One hundred and fifty-six out of 206 patients developed PM/DM/ADM associated lung diseases, including 106 cases (51.46%) of interstitial lung disease (ILD).There was no significant difference in gender

  15. 胎儿超声心动图在先天性心脏病产前诊断中的临床价值

    Institute of Scientific and Technical Information of China (English)

    杨岚; 茹彤; 顾燕; 杨燕; 戴晨燕; 杨丽娟; 徐燕


    systematical structural screening were taken fetal echocardiography and 172 cases of fetal congenital heart diseases were found,which owns 97.7% of the whole cases.②Within the same 176 cases,fetal echocar-diography indicated normal for the 4 cases of possibly ventricular septal defect indicated by systematical structural screening (ventricular septal defect<2.0 mm),and they were verified by the postnatal neonatal echocardiography.Termination of pregnancy was found in 111 cases,7 cases of which were also autopsied in our hospital,with the result of autopsy corresponding to that of prenatal echocardiography.61 cases continued the pregnancy,where 55 cases of systematical structural screening,fetal echocardiography and postpartum were identical to each other.1 case indicated that ventricular septal defect and aortic overriding by echocardiography for the fetal with enlarged right ventricle indicated by systematical structural screen-ing,then verified by the postnatal echocardiography.1 case indicated double aortic arch by echocardio-graphy for the fetal with right aortic arch indicated by systematical structural screening,followed by the verification of postnatal echocardiography.2 cases indicates normal by postnatal echocardiography for the fetal with ventricular septal defect indicated by prenatal ultrasound.1 case was misdiagnosed coarctation of the aorta and the last case was missed anomalous pulmonary venous connection.Conclusions Fetal echo-cardiography with high prenatal detection rate of congenital heart disease is one of the important methods of prenatal screening for fetal congenital heart disease.

  16. 门控心肌灌注显像在老年左心力衰竭患者中的应用价值%Application of gated myocawdial pewfusion imaging in eldewly patients with left-sided heawt failuwe

    Institute of Scientific and Technical Information of China (English)

    高玲; 贾鹏


    [Abstwact] Objective To investigate the clinical application of gated myocardial perfusion imaging combined with ultrasonic cardiography in elderly patients with left-sided heart failure and normal left ventricular ej ection fraction (LVEF ),thereby providing an important basis for the management of clinical heart failure. Methods Hospitalized patients with left-sided heart failure were divided into two groups,one with normal LVEF(n= 46 )and the other with reduced LVEF(n=60). Of the 106 patients,39 were male and 67 female,aged between 60 and 85 years,with an average age of 69. 8±16. 8. Gated myocardial perfusion imaging was performed for patients in both groups, recording stress/rest left ventricular end-systolic volume and end-diastolic volume in duplicate,andχ2 test was conducted to detect differences in ischemic area and ventricular volume between the two groups. Results In the group with normal LVEF,gated myocardial perfusion imaging identified mild ischemia in 11 cases,moderate ischemia in 22 cases and severe ischemia in 13 cases,with the ischemic area at(15. 6±6. 6)%,the standard deviation at -2. 3±1. 1 and LVEF at(56. 8±9. 6)%. In the group with reduced LVEF,mild ischemia was found in 8 cases,moderate ischemia in 27 cases and severe ischemia in 15 cases,with the ischemic area at(22. 0±8. 6)%,the standard deviation at -3. 1±2. 6 and LVEF at 31. 9±6. 5%. Differences in ischemic area,severity of ischemia and LVEF between the groups were statistically significant(all P<0. 01 ),as were differences in stress end-diastolic volume, rest end-diastolic volume,stress end-systolic volume and rest end-systolic volume(all P<0. 01 ),and differences in left ventricular end-diastolic diameter,diastolic interventricular septal thickness,posterior left ventricular wall end-diastolic thickness and left ventricular apical diastolic myocardial thickness(all P<0. 01 ). Conclusions Gated myocardial perfusion imaging is a valuable clinical tool in the diagnosis and

  17. Acute purulent pericarditis caused by Streptococcus pneumoniae: a case report and literature review%肺炎链球菌致急性化脓性心包炎1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    刘金荣; 姚开虎; 高路; 徐保平


    Objective To improve the understanding to acute purulent pericarditis caused by Streptococcus Pneumoniae ( PPSP ) ,to report a case of acute PPSP serotype 6A in a Chinese child and 16 reported cases by English literature on this topic up to now. Methods Clinical manifestation and prognosis of 17 patients ( including our reported case in this article ) with acute purulent pericarditis caused by Streptococcus Pneumoniae were retrospectively analyzed. Results A 14-month-old previously healthy boy had a history with 7-day-tachypnea and 3-day-cough. The levels of white blood cell ( WBC ) and C-reactive protein ( CRP ) were significantly high. A computed tomographic imaging of the chest and echocardiographic stud)' showed massive pericardial fluid. Streptococcus Pneumoniae serotype 6A was recovered from pericardial fluid and was found to be sensitive to penicillin. The patient was diagnosed as PPSP and treated with intravenous infusion of cefamandole and linezolid successively. On the 19th day of hospitalization the patient was discharged in good general condition and with hemodynamically stable. Over 6 months follow-up, ultrasound cardiography only revealed a little thickening cardiac pericardium. Since 1990, only 16 cases of PPSP have been reported in children in the PubMed databases. 17 cases ( 9 males,7 females, 1 unknown ) aged from 4 months to 17 years, 10 cases were younger than 2 years old. Children were healthy without previous medical conditions and only 3cases had underlying diseases. Its clinical recognition was difficult due to insidiously subtle and varied presentations,but most of cases had fever, dyspnea and cough. The levels of WBC, neutrophil and C-reactive protein were very high. Pericardial fluid was often yellowish-brown and revealed typical manifestation of purulent pericarditis. Echocardiogram and chest CT/X ray showed a large amount of pericardial effusion, man)' cases showed pneumonia pleural effussion. 8 cases were with penicillin susceptible

  18. Clinical Significance of Diurnal Rhythmic Fluctuations of Blood Pressures in Hypertensions%高血压患者血压昼夜节律变化的临床意义

    Institute of Scientific and Technical Information of China (English)

    陈卫文; 林靖宇; 李景霞


    律与临床意义.方法:对112例高血压患者根据超声心动图( ultrasonic cardiography,UCG)检查结果分成3组,其中UCG显示左室肥大30例,均伴单纯收缩压升高(isolated systolic hypertension,ISH)或收缩压和舒张压均升高(miscellaneous systolic and diastolic hypertension,MDH),平均年龄(58±12.1)岁,为LVH组;UCG正常的ISH患者48例为ISH组,平均年龄(62±15.2)岁;UCG正常的MDH患者34例为MDH组,平均年龄(51±12.0)岁.另选健康体检者中动态血压监测(ambulatory blood pressure monitoring,ABPM)正常的30例为对照组,平均年龄(54±10.3)岁.获取4组研究对象的24 h平均收缩压(24-hour mean systolic blood pressure,24 hSBP)和舒张压(24-hourmean diastolic blood pressure,24 h DBP)、白昼平均收缩压(daytime mean systolic blood pressure,dSBP)和舒张压(daytime mean diastolic blood pressure,dDBP)、夜间平均收缩压(nighttime mean systolic blood pressure,nSBP)和舒张压(nighttime mean diastolic blood pressure,nDBP)、夜间/白昼平均收缩压比值(nSBP/dSBP)和舒张压比值(nDBP/dDBP)、收缩压负荷值与舒张压负荷值.结果:(1)正常组和ISH组血压均值波动都具有昼夜规律性,但其曲线有所不同;MDH组夜间血压下降幅度减小,LVH组昼夜规律不明显;(2)ISH组、MDH组与LVH组24 hSBP、dSBP、nSBP均高于对照组,而以ISH组及LVH组更为显著(P<0.001);(3) MDH组与LVH组nDBP/dDBP均显著高于对照组;(4)LVH组nSBP/dSBP比值及nDBP/dDBP比值显著高于对照组;(5)SBP负荷值LVH组大于MDH组,DBP负荷值LVH组小于MDH组.结论:高血病患者应积极随访动态血压监测,以观察血压升高的水平及昼夜节律的变化,并有针对性地进行干预,这对降低心脑血管疾病发生的风险有重要意义.

  19. Risk factor of mortality in systemic sclerosis of Han nationality%系统性硬化病患者死亡危险因素分析

    Institute of Scientific and Technical Information of China (English)

    姚中强; 栗占国; 于孟学; 刘湘源


    Objective To determine the prognostic factors in systemic sclerosis.Methods Clinical data of definite systemic sclerosis patients were collected,including disease onset age,sex,disease course,Raynaud's phenomenon,skin involvement,gastroesophageal reflux,interstitial pneumonia,cardiac lesions,kidney lesions and scleroderma renal crisis.serum antibodies to scl-70.RNP and anti-centromere antibody were detected.Pulmonary artery pressure was measured by ultrasound cardiography.Cox hazard ratio model was employed to assess the mortality risk of systemic sclerosis patients.Results No difference in Raynaud's phenomenon,gastroesophageal reflux,anti-nuclear antybody,anti-sol-70 antibody,anti-centromere antibody,interstitial pneumonia,diffusion capacity (DLco),coronary artery disease,and peripheral artery atherosclerotic disease could be found between the dead and alive systemic sclerosis patients(P>0.05).Dead systemic sclerosis patients had later disease,onset(older than 60 years old)(P=0.002).Male gender(P=0.023),more diffuse skin involvement(P=0.000),more positive anti-RNP antibody(P=0.014),more pulmonary artery hypertension(P=0.000).more cardiac lesions(P=0.000),more cerebral infarets (P=0.035),more kidney lesions(P=0.000),and more scleroderma renal crisis(P=0.000) could be found jn dead sclerosis patients.Cox regression analysis showed that,onset later than 60 years old(OR=5.441.95% CI 2.126~13.926,P=0.000),male sex (OR=5.531,95%CI 2.014~15.190,P=0.001),anti-RNP antibedy positivity (OR=2.664,95%CI 1.016~6.592,P=0.034),diffuse skin involvement(OR=3.432,95%CI 1.400~8.411,P=0.007),pulmonary artery hypertension (OR=25.718,95% CI 5.954~111.085,P=0.000),cardiac lesions (OR=4.141.95%CI 1.685~10.159,P=0.002),kidney lesions(OR=4.214,95%CI 1.654~10.737,P=0.003) and scleroderma renal crisis (OR=20.677,95% CI 4.161~102.764.P=0.000)were risk factors for mortality in systemic sclerosis.Severe pulmonary hypertension was the most strong predictive factor for mortality in

  20. Effects of levocarnitine combined with trimetazidine on left ventricular remodeling in maintenance hemodialysis patients%左卡尼汀和曲美他嗪联合治疗对维持性血液透析患者左心室重塑的影响

    Institute of Scientific and Technical Information of China (English)

    邬碧波; 张黎明; 梅长林; 唐琦; 芦怡舟


    Objective To investigate the effects of levocarnitine combined with urimetazidine on left ventricular remodeling in maintenance hemodialysis(MHD)patients.Methods All of 86 MHD patients and 40 healthy volunteers(health control group)were involved in the study.all of 86 MHD patients were randomly divided into two groups,disease treatment group(46 cases)and disease control group(40 cases),who had undergone hemodialysis for at least 3 months before the study and were in a stable clinical status without signs of infection or disease activity.In disease treatment group,1.0 g of levocarnitine was infused at the end of each dialysis treatment and 20 mg of trimetazidine was taken orally 3 times each day for 6 months,while the parameters for free fatty acid(FFA),free carnitine(FC),inflammation and oxidative stress were studied before and after the treatmenL In disease control group these two drugs were not used.The left ventricular end-diastolic diameter(LVDd),left ventricuhr end-systolic diameter(LVDs),left atrial diameter (LAD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF)were detected by ultrasonic cardiography.Results Before treatment,the serum levels of FFA,high-sensitivity C-reactive protein(hs-CRP),intedeukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-αand malondialdehyde(MDA)were higher in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01),while the serum levels of FC,glutathione peroxidase(GSHPx)and superoxide dismutase(SOD)were lower in disease treatment group and disease control group than those in health control group(P<0.05 or<0.01).Compared with those before treatment,the serum levels of FFA,hs-CRP,IL-1β,IL-6,TNF-α,MDA were decreased(P<0.05 or<0.01),FC,GSHPx,SOD were increased(P<0.05 or<0101),the scores of LVDd,LAD,IVST,LVPWT,LVMI were also decreased significantly(P<0.05),while LVEF increased markedly after treatmem in disease

  1. Situação da assistência médico-sanitária e hospitalar no Estado do Ceará, Brasil Medical care situation in the State of Ceara, Brazil

    Directory of Open Access Journals (Sweden)

    João Yunes


    near to the required one unit per each 50,000 inhabitants. The qualitative appreciation, considered indirectly through the actual laboratory and human resources, seemed to be inefficient since only 16.7% of the health units have laboratory and 12.3% have no physicians; 21.7 (39 of the health center are closed because of the lack of this kind of professional related above. Paralel to this situation one can detect the existance of equipments completely out of date and the nearly absolute defficiency in the section of drug supply. From the 141 towns which compose the Region of Ceara, 31 (22% have no health unit and in 25 (17.7% we don't find any health resource. In the first presented case the population of medical care theoretically found out is of 378,449 inhabitants and in the second case it is of 232,900 inhabitants. From the 103 actual hospitals in this present Region 77.7% is on the responsability of the private section and 25% is concentrated in the capital of the Region. The quantitative standard of 1.84 beds/1000 inhabitants (7047 beds is extremely low when compared with the Brazilian average of 3.6 beds. The theoretically recomended average is 4.5 (beds. From the total number of beds 1.10/1000 are considered general and 0.74/1000 are specialized (tuberculosis, leprosy and psychiatry. The qualitative stantard of the hospital attendance is implicated since only 22.3% of the foundation have laboratory; 31.1% have X Ray apparatus and 11.6% present electro-cardiography. The most proeminent shortage of these resources occur in the countryside of this Region. More than 50.0% of the hospitals have no professional on health section, such us nursery, nutritionist, social work and technicians. From the 141 towns, 62.7% (89 have no hospitals, consequently about 1,300.000 inhabitants are theoretically in need of hospital care. Related to the 86 para-hospital units, through the lack of data is bigger, the situation is rather similar to the hospital care. There are 1207